Provider Demographics
NPI:1275175929
Name:FIVE STAR VAN TRANSPORTATION
Entity Type:Organization
Organization Name:FIVE STAR VAN TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARQUELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:AUGUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-635-9696
Mailing Address - Street 1:1827 INDUSTRY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-1119
Mailing Address - Country:US
Mailing Address - Phone:504-635-9696
Mailing Address - Fax:
Practice Address - Street 1:5761 WILTON DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3435
Practice Address - Country:US
Practice Address - Phone:504-635-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)