Healthcare Provider Details

I. General information

NPI: 1184560963
Provider Name (Legal Business Name): OLIVE SPRING HEALTHCARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 REGENT DR
MATTESON IL
60443-3088
US

IV. Provider business mailing address

998 REGENT DR
MATTESON IL
60443-3088
US

V. Phone/Fax

Practice location:
  • Phone: 832-679-2277
  • Fax:
Mailing address:
  • Phone: 832-679-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AYOMIKUN R OLOWOSELU DADA
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 832-679-2277