Provider Demographics
NPI:1598369597
Name:STAR LIFE LLC
Entity Type:Organization
Organization Name:STAR LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-451-4982
Mailing Address - Street 1:HC 59 BOX 6502
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9667
Mailing Address - Country:US
Mailing Address - Phone:787-451-4982
Mailing Address - Fax:787-868-0348
Practice Address - Street 1:CARR # 2 KM 137.8 INT BO. CERRO GORDO
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9667
Practice Address - Country:US
Practice Address - Phone:787-451-4982
Practice Address - Fax:787-868-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport