Healthcare Provider Details

I. General information

NPI: 1598415465
Provider Name (Legal Business Name): YETI HOME HEALTH CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 S PARKER RD STE 422
AURORA CO
80014-2725
US

IV. Provider business mailing address

2851 S PARKER RD STE 422
AURORA CO
80014-2725
US

V. Phone/Fax

Practice location:
  • Phone: 720-240-7756
  • Fax:
Mailing address:
  • Phone: 720-240-7756
  • Fax: 720-745-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SOLOMON NALYANYA
Title or Position: CEO
Credential: CPA
Phone: 720-240-7756