Provider Demographics
NPI:1881187839
Name:OLIVE HEALTHCARE LLC
Entity Type:Organization
Organization Name:OLIVE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUSOLA
Authorized Official - Middle Name:AYODEJI
Authorized Official - Last Name:AGUNBIADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-886-6206
Mailing Address - Street 1:5836 JAMES AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2648
Mailing Address - Country:US
Mailing Address - Phone:612-886-6206
Mailing Address - Fax:612-324-7402
Practice Address - Street 1:5836 JAMES AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-3421
Practice Address - Country:US
Practice Address - Phone:612-886-6206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN384331251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health