Healthcare Provider Details

I. General information

NPI: 1740924547
Provider Name (Legal Business Name): STARELIANCE LOGISTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4158 ROLLINS AVE
MOBILE AL
36618-1537
US

IV. Provider business mailing address

4158 ROLLINS AVE
MOBILE AL
36618-1537
US

V. Phone/Fax

Practice location:
  • Phone: 251-509-1333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. SUPORIA MOORE
Title or Position: OWNER
Credential:
Phone: 251-509-1333