Healthcare Provider Details

I. General information

NPI: 1174343453
Provider Name (Legal Business Name): NISSI HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15290 E 6TH AVE UNIT 210D
AURORA CO
80011-3449
US

IV. Provider business mailing address

15290 E 6TH AVE UNIT 210D
AURORA CO
80011-3449
US

V. Phone/Fax

Practice location:
  • Phone: 720-594-0593
  • Fax:
Mailing address:
  • Phone: 720-594-0593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. VICTOR OLUTOSIN AJAYI
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 720-594-0593