=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649166927
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RISING HOPE STAR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2025
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4454 HILL AVE APT C204
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43615-5451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-901-4871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4454 HILL AVE APT C204
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43615-5451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-901-4871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. CRYSTAL L GAUSE-LAGAT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-901-4871
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------