Organization
CARESTAR
Active
Other names
Medicaid Private Provider
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RENEE LOUISE CANNING LPN (LICENSE PRACTICAL NURSE)
(614) 860-9307
Entity
Organization
Contact information
Practice address
3035 FALCON BRIDGE DR, COLUMBUS, OH 43232-5428
(614) 860-9307
Mailing address
3035 FALCON BRIDGE DR, COLUMBUS, OH 43232-5428
(614) 860-9307
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
RP008385
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2702418
—
OH
Enumeration date
03/12/2007
Last updated
03/24/2008
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