Healthcare Provider Details

I. General information

NPI: 1760337091
Provider Name (Legal Business Name): PASSIONATE HANDS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6324C BASS LAKE RD
CRYSTAL MN
55428-3518
US

IV. Provider business mailing address

6324C BASS LAKE RD
CRYSTAL MN
55428-3518
US

V. Phone/Fax

Practice location:
  • Phone: 763-228-6085
  • Fax:
Mailing address:
  • Phone: 763-228-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: ANGELA WILSON-DOE
Title or Position: REGISTERED NURSE
Credential:
Phone: 763-777-0961