Provider Demographics
NPI:1790563351
Name:FIVE STAR CARE AMBULANCE
Entity Type:Organization
Organization Name:FIVE STAR CARE AMBULANCE
Other - Org Name:FIVE STAR AMBULANCE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNIER
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-942-6356
Mailing Address - Street 1:HC 1 BOX 7434
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-9737
Mailing Address - Country:US
Mailing Address - Phone:787-942-6356
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION RIO PIEDRAS HEIGHTS
Practice Address - Street 2:CALLE PARANA 1711
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-942-6356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport