Healthcare Provider Details

I. General information

NPI: 1477400091
Provider Name (Legal Business Name): INTENTIONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N MICHIGAN ST STE D4
TOLEDO OH
43604-5646
US

IV. Provider business mailing address

421 N MICHIGAN ST STE D4
TOLEDO OH
43604-5646
US

V. Phone/Fax

Practice location:
  • Phone: 586-298-1647
  • Fax: 313-744-7455
Mailing address:
  • Phone: 586-298-1647
  • Fax: 313-744-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: KYRA ANDREWS
Title or Position: OWNER
Credential: RMA
Phone: 313-400-9913