Healthcare Provider Details

I. General information

NPI: 1083808208
Provider Name (Legal Business Name): OLIDIA CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7530 MARKET PLACE DR
EDEN PRAIRIE MN
55344-3636
US

IV. Provider business mailing address

4105 85TH AVE N STE 101
BROOKLYN PARK MN
55443-2055
US

V. Phone/Fax

Practice location:
  • Phone: 763-634-5994
  • Fax: 763-634-5997
Mailing address:
  • Phone: 763-634-5994
  • Fax: 763-634-5997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number25418
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. OLIVIER B NKWONKAM
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 612-567-7780