Organization
CARE STAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY DANYELLE VANCE (INDEPENDENT LIVING SERVICES PROVIDE)
(740) 244-3309
Entity
Organization
Contact information
Practice address
682 HARDING RD, MARION, OH 43302-5431
(740) 383-5897
Mailing address
1196 MARTINIQUE DR, MARION, OH 43302-1679
(740) 244-3309
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
266764
OH
310500000X
Mental Illness Intermediate Care Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2606764
—
OH
Enumeration date
09/12/2006
Last updated
08/22/2020
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