Organization
OMOCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAPHAEL OMODUNMIJU RN (ADMINISTRATOR)
(612) 298-2513
Entity
Organization
Contact information
Practice address
3300 COUNTY ROAD 10 STE 200A, BROOKLYN CENTER, MN 55429-3065
(763) 607-4300
(612) 351-4259
Mailing address
7708 67TH AVE N, BROOKLYN PARK, MN 55428-2212
(762) 607-4300
(612) 351-4259
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
379629
MN
251J00000X
Nursing Care Agency
Primary
379629
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32623
MINNESOTA STATE DEPARTMENT OF HEALTH
MN
Enumeration date
11/27/2016
Last updated
07/21/2022
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