Healthcare Provider Details

I. General information

NPI: 1568380301
Provider Name (Legal Business Name): POM & JO HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12205 E 2ND DR
AURORA CO
80011-8326
US

IV. Provider business mailing address

12205 E 2ND DR
AURORA CO
80011-8326
US

V. Phone/Fax

Practice location:
  • Phone: 720-329-4604
  • Fax:
Mailing address:
  • Phone: 720-329-4604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: FREZER S YIRDAW
Title or Position: MANAGING MEMBER
Credential:
Phone: 720-329-4604