Healthcare Provider Details

I. General information

NPI: 1033213509
Provider Name (Legal Business Name): CARE STAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 HARDING RD
MARION OH
43302-5431
US

IV. Provider business mailing address

1196 MARTINIQUE DR
MARION OH
43302-1679
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-5897
  • Fax:
Mailing address:
  • Phone: 740-244-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number266764
License Number StateOH

VIII. Authorized Official

Name: ASHLEY DANYELLE VANCE
Title or Position: INDEPENDENT LIVING SERVICES PROVIDE
Credential:
Phone: 740-244-3309