Organization Active NPI

Impact Homehealth Care Agency LLC

  • Home Health Agency
  • Aurora, CO
National Provider Identifier
1124738737
Registry record updated Jun 19, 2026
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Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
IMPACT HOMEHEALTH CARE AGENCY LLC
Practice address
17524 E Dickenson PL
Aurora, CO 80013-4178
Phone
(720) 495-6737
NPI assigned
Dec 5, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tigist Woldegiorgis
Title
Owner/Vice President
Phone
(720) 695-9993

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

17524 E Dickenson PL
Aurora, CO 80013-4178

Mailing address

17524 E Dickenson PL
Aurora, CO 80013-4178
Phone (720) 695-9993

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240815002499 CO Part A Provider - Home Health Agency 5395283832 Practice locations: Aurora, CO

Home health agency certification: CCN 067659

Legal name
IMPACT HOMEHEALTH CARE AGENCY LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 23, 2025
Last certification
Dec 18, 2025
Organization structure
LLCProprietary
Enrollment address
17524 E Dickenson PL
Aurora, CO 80013-4178

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mebratu Shibabaw Individual 5% Or Greater Direct Ownership InterestOwner/President/Treasurer/Alt Admin Dec 5, 2022 50%
Corporate OfficerOwner/President/Treasurer/Alt Admin Dec 5, 2022 50%
Corporate DirectorOwner/President/Treasurer/Alt Admin Dec 5, 2022 50%
W-2 Managing EmployeeAlt Admin Dec 5, 2022 25%
Melese Altaye Individual W-2 Managing EmployeeAlternate Director of Nursing Dec 5, 2022 25%
Tigist Woldegiorgis Individual 5% Or Greater Direct Ownership InterestOwner/Vice President/Secretary/Don Dec 5, 2022 50%
Corporate OfficerOwner/Vice President/Secretary/Don Dec 5, 2022 50%
Corporate DirectorOwner/Vice President/Secretary/Don Dec 5, 2022 50%
W-2 Managing EmployeeDon Dec 5, 2022 25%
Sisay Golla Individual W-2 Managing EmployeeAd; Dec 5, 2022 25%

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1670198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781827200000",
    "number": "1124738737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17524 E DICKENSON PL",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800134178",
            "telephone_number": "720-695-9993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17524 E DICKENSON PL",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800134178",
            "telephone_number": "720-495-6737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT HOMEHEALTH CARE AGENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-05",
        "last_updated": "2026-06-19",
        "certification_date": "2026-06-19",
        "status": "A",
        "authorized_official_last_name": "WOLDEGIORGIS",
        "authorized_official_first_name": "TIGIST",
        "authorized_official_title_or_position": "OWNER/VICE PRESIDENT",
        "authorized_official_telephone_number": "720-695-9993"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.