Provider Demographics
NPI:1548832678
Name:FIVE STAR NON-EMERGENCY MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:FIVE STAR NON-EMERGENCY MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:BOOKER
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-490-7570
Mailing Address - Street 1:PO BOX 470323
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-0323
Mailing Address - Country:US
Mailing Address - Phone:310-490-7570
Mailing Address - Fax:
Practice Address - Street 1:1800 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-2560
Practice Address - Country:US
Practice Address - Phone:310-490-7570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)