Provider Demographics
NPI:1407503675
Name:LUNA STAR TRANSIT LLC
Entity Type:Organization
Organization Name:LUNA STAR TRANSIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CORISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:888-850-3586
Mailing Address - Street 1:1721 BARTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-3743
Mailing Address - Country:US
Mailing Address - Phone:888-850-3586
Mailing Address - Fax:
Practice Address - Street 1:430 N HORSMAN ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61101-6608
Practice Address - Country:US
Practice Address - Phone:888-850-3586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)