Provider Demographics
NPI:1003565599
Name:STARLIGHT NON EMERGENCY MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:STARLIGHT NON EMERGENCY MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DRIVER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLAISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-764-6404
Mailing Address - Street 1:90 STATE ST
Mailing Address - Street 2:SUITE 700, OFFICE 40
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-1716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:90 STATE ST
Practice Address - Street 2:SUITE 700, OFFICE 40
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-1716
Practice Address - Country:US
Practice Address - Phone:518-764-6404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)