Provider Demographics
NPI:1043433113
Name:CARESTAR
Entity Type:Organization
Organization Name:CARESTAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPANT PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-382-5425
Mailing Address - Street 1:134 E COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-3904
Mailing Address - Country:US
Mailing Address - Phone:740-382-5425
Mailing Address - Fax:
Practice Address - Street 1:134 E COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-3904
Practice Address - Country:US
Practice Address - Phone:740-382-5425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2148170Medicaid