Provider Demographics
NPI:1346477098
Name:CRANDELL'S ENTERPRISE'S INC.
Entity Type:Organization
Organization Name:CRANDELL'S ENTERPRISE'S INC.
Other - Org Name:ANN'S FAMILY CARE HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-790-7663
Mailing Address - Street 1:5312 SIX FORKS RD
Mailing Address - Street 2:301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4458
Mailing Address - Country:US
Mailing Address - Phone:919-790-7663
Mailing Address - Fax:919-790-7139
Practice Address - Street 1:5312 SIX FORKS RD
Practice Address - Street 2:301
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4458
Practice Address - Country:US
Practice Address - Phone:919-790-7663
Practice Address - Fax:919-790-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 251S00000X, 261QM0850X, 311ZA0620X
NCFCL-092-084261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care HomeGroup - Single Specialty