Healthcare Provider Details

I. General information

NPI: 1952178360
Provider Name (Legal Business Name): INTENTIONALLY RAISING INDIVIDUAL STANDARDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 N DETROIT AVE
TOLEDO OH
43607-3929
US

IV. Provider business mailing address

816 N DETROIT AVE
TOLEDO OH
43607-3929
US

V. Phone/Fax

Practice location:
  • Phone: 567-868-1604
  • Fax:
Mailing address:
  • Phone: 567-868-1604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMICA L WINSTON
Title or Position: DOO
Credential:
Phone: 567-868-1604