Healthcare Provider Details

I. General information

NPI: 1891652673
Provider Name (Legal Business Name): INTENTIONAL HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STOVEPIPE ALLY ROAD
MONROE ME
04951
US

IV. Provider business mailing address

201 STOVEPIPE ALLY ROAD
MONROE ME
04951
US

V. Phone/Fax

Practice location:
  • Phone: 404-451-1271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBBIN LEAGUE
Title or Position: OWNER
Credential: FNP-C
Phone: 404-451-1271