Healthcare Provider Details

I. General information

NPI: 1184046963
Provider Name (Legal Business Name): CAREGIVERS MAKING A DIFFERENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1879 STATION PKWY NW
ANDOVER MN
55304-4880
US

IV. Provider business mailing address

1879 STATION PKWY NW
ANDOVER MN
55304-4880
US

V. Phone/Fax

Practice location:
  • Phone: 763-205-4440
  • Fax: 763-205-4403
Mailing address:
  • Phone: 763-205-4440
  • Fax: 763-205-4403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number363457
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN MICHAEL MCDONALD
Title or Position: PRESIDENT
Credential:
Phone: 763-205-4440