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General NPI Number Information
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NPI Number | 1508309451
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Entity Type | Organization
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Legal Business Name | OMOCARE LLC
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Dates
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Enumeration Date | 11/27/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3300 COUNTY ROAD 10 STE 200A
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-3065
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Country | US
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Telephone | 763-607-4300
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Fax | 612-351-4259
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Provider Business Mailing Address
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Address Line | 7708 67TH AVE N
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City | BROOKLYN PARK
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State | MN
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Zip | 55428-2212
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Country | US
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Telephone | 762-607-4300
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Fax | 612-351-4259
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RAPHAEL OMODUNMIJU
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Credential | RN
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Telephone | 612-298-2513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 379629
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 379629
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License Number State | MN
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