MEDICARE: INTENTIONALLY RAISING INDIVIDUAL STANDARDS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	385H00000X	Respite Care
3	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1952178360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTENTIONALLY RAISING INDIVIDUAL STANDARDS LLC

Provider Business Mailing Address
First Line	:	816 N DETROIT AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-3929
Country	:	US
Telephone Number	:	567-868-1604
Fax Number	:

Provider Business Practice Location Address
First Line	:	816 N DETROIT AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-3929
Country	:	US
Telephone Number	:	567-868-1604
Fax Number	:

Authorized Official
Title or Position	:	DOO
Name	:	JAMICA L WINSTON
Credential	:
Telephone Number	:	567-868-1604

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	03/27/2026

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