# CARESTAR

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medicaid Private Provider
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942332069
- **Authorized official:** MRS. RENEE LOUISE CANNING LPN (LICENSE PRACTICAL NURSE)
- **Authorized official phone:** (614) 860-9307

## Contact information

- **Practice address:** 3035 FALCON BRIDGE DR, COLUMBUS, OH 43232-5428
- **Practice address phone:** (614) 860-9307
- **Mailing address:** 3035 FALCON BRIDGE DR, COLUMBUS, OH 43232-5428
- **Mailing address phone:** (614) 860-9307

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | RP008385 | OH | Yes |

## Other

- **Enumeration date:** 03/12/2007
- **Last updated:** 03/24/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2702418 | — | OH |