Provider Demographics
NPI:1659930493
Name:GOODSTAR SERVICES LLC
Entity Type:Organization
Organization Name:GOODSTAR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:CALLIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:419-901-4200
Mailing Address - Street 1:2549 W VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-4751
Mailing Address - Country:US
Mailing Address - Phone:419-901-4200
Mailing Address - Fax:
Practice Address - Street 1:2549 W VILLAGE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-4751
Practice Address - Country:US
Practice Address - Phone:419-901-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0275196Medicaid