Healthcare Provider Details

I. General information

NPI: 1356010078
Provider Name (Legal Business Name): ADDIS HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S JOLIET ST STE 101
AURORA CO
80012-3150
US

IV. Provider business mailing address

1010 S JOLIET ST STE 101
AURORA CO
80012-3150
US

V. Phone/Fax

Practice location:
  • Phone: 303-337-7799
  • Fax: 303-337-0017
Mailing address:
  • Phone: 303-337-7799
  • Fax: 303-337-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMARE GEREMEW
Title or Position: ADMINISTRATOR
Credential:
Phone: 303-886-8894