Healthcare Provider Details

I. General information

NPI: 1144154790
Provider Name (Legal Business Name): LEGENDARY & DIVINE HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 S PAGOSA WAY
AURORA CO
80013-2067
US

IV. Provider business mailing address

3491 S PAGOSA WAY
AURORA CO
80013-2067
US

V. Phone/Fax

Practice location:
  • Phone: 720-757-2433
  • Fax:
Mailing address:
  • Phone: 720-757-2433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DEAHZANEA D WELLS
Title or Position: OWNER
Credential:
Phone: 720-757-2433