Tibli Olandrus Dickson, MANAGER
Individual provider Active NPI Nursing Home Administrator · Champlin, MN
NPI 1003615030 · NPPES record last updated Mar 11, 2025
Key facts
- NPI
- 1003615030
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nursing Home Administrator 376G00000X
- Practice address
- 7400 122ND Ave N
Champlin, MN 55316-2127 - Phone
- (612) 865-6220
- NPI assigned
- Mar 11, 2025
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Zeor Healthcare LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Home Administrator | 376G00000X | Yes |
Addresses
Primary practice location
7400 122ND Ave N
Champlin, MN 55316-2127
Mailing address
7400 122ND Ave N
Champlin, MN 55316-2127
Phone (612) 865-6220
Other providers in Champlin, MN
- Daziah LLC
- Daziah LLC
- Dental Specialists of Minnesota, PLLC
- Dentalign, PA
- Pandora Bazen Dickson
- Dimensions Chiropractic and Wellness
- Diverse Health and Social Services LLC
- Paul John Dousi
- Arielle Dudundane
- Ajibola Jelilat Edwards
All providers in Champlin, MN · Nursing Home Administrator in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.