MEDICARE: SHANDIIN HOME HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1659213353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANDIIN HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	86 GRANADA DR
Second Line	:
City	:	WHITE ROCK
State	:	NM
Zip	:	87547-3726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	86 GRANADA DR
Second Line	:
City	:	WHITE ROCK
State	:	NM
Zip	:	87547-3726
Country	:	US
Telephone Number	:	970-570-9773
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	SEMBERLYN CROSSLEY
Credential	:	RN
Telephone Number	:	970-570-9773

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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