Provider Demographics
NPI:1427360114
Name:OLYDIA HOME CARE INC
Entity Type:Organization
Organization Name:OLYDIA HOME CARE INC
Other - Org Name:OLIDIA SERVICES INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:NKWONKAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-761-4403
Mailing Address - Street 1:7530 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3636
Mailing Address - Country:US
Mailing Address - Phone:651-270-3614
Mailing Address - Fax:
Practice Address - Street 1:7530 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3636
Practice Address - Country:US
Practice Address - Phone:612-703-6144
Practice Address - Fax:763-634-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health