Provider Demographics
NPI:1396386256
Name:BORN TO STAND OUT
Entity type:Organization
Organization Name:BORN TO STAND OUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CEO
Authorized Official - Phone:330-353-4991
Mailing Address - Street 1:2715 SANDY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-8210
Mailing Address - Country:US
Mailing Address - Phone:330-353-4991
Mailing Address - Fax:
Practice Address - Street 1:2715 SANDY LAKE RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-8210
Practice Address - Country:US
Practice Address - Phone:330-353-4991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0351262Medicaid