Healthcare Provider Details

I. General information

NPI: 1659214096
Provider Name (Legal Business Name): KEYSTONE HOME HEALTH AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 E MISSISSIPPI AVE STE 112
AURORA CO
80012-3186
US

IV. Provider business mailing address

11111 E MISSISSIPPI AVE STE 112
AURORA CO
80012-3186
US

V. Phone/Fax

Practice location:
  • Phone: 303-755-5542
  • Fax:
Mailing address:
  • Phone: 303-755-5542
  • Fax:

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: FATIMAH AISHA JOHNSON II
Title or Position: ADMINISTRATOR
Credential:
Phone: 303-755-5542