Healthcare Provider Details

I. General information

NPI: 1043433113
Provider Name (Legal Business Name): CARESTAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 E COLUMBIA ST
MARION OH
43302-3904
US

IV. Provider business mailing address

134 E COLUMBIA ST
MARION OH
43302-3904
US

V. Phone/Fax

Practice location:
  • Phone: 740-382-5425
  • Fax:
Mailing address:
  • Phone: 740-382-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateOH

VIII. Authorized Official

Name: JULIE A BRYAN
Title or Position: INDEPANT PROVIDER
Credential:
Phone: 740-382-5425