Provider Demographics
NPI:1639541915
Name:GOLD STAR LLC
Entity Type:Organization
Organization Name:GOLD STAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMEDNOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-275-0075
Mailing Address - Street 1:9002 E AMHERST DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4085
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9002 E AMHERST DR
Practice Address - Street 2:UNIT C
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4085
Practice Address - Country:US
Practice Address - Phone:720-275-0075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20151383063343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)