Provider Demographics
NPI:1134633704
Name:OVERCOMER HEALTHCARE SERVICE CORPORATION
Entity type:Organization
Organization Name:OVERCOMER HEALTHCARE SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLANIYI
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEKU
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:651-500-6975
Mailing Address - Street 1:2439 HOMESTEAD AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5120
Mailing Address - Country:US
Mailing Address - Phone:651-500-6975
Mailing Address - Fax:
Practice Address - Street 1:1238 BIRMINGHAM ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2116
Practice Address - Country:US
Practice Address - Phone:651-500-6975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-18
Last Update Date:2017-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN382067163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty