Provider Demographics
NPI:1871321174
Name:MAKING A DIFFERENCE LLC
Entity type:Organization
Organization Name:MAKING A DIFFERENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-367-0395
Mailing Address - Street 1:1657 COMMERCE DR STE 8B
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-1542
Mailing Address - Country:US
Mailing Address - Phone:574-367-0395
Mailing Address - Fax:844-894-8398
Practice Address - Street 1:1657 COMMERCE DR STE 8B
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-1542
Practice Address - Country:US
Practice Address - Phone:574-367-0395
Practice Address - Fax:844-894-8398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health