Provider Demographics
NPI:1144864588
Name:JLS STARS LLC
Entity type:Organization
Organization Name:JLS STARS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-818-9101
Mailing Address - Street 1:15137 CHESHIRE ST
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5340
Mailing Address - Country:US
Mailing Address - Phone:562-818-9101
Mailing Address - Fax:
Practice Address - Street 1:15137 CHESHIRE ST
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-5340
Practice Address - Country:US
Practice Address - Phone:562-818-9101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)