Healthcare Provider Details

I. General information

NPI: 1699090811
Provider Name (Legal Business Name): STAR COACH PERFORMANCE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 CURRAHEE PL
TOCCOA GA
30577-9651
US

IV. Provider business mailing address

PO BOX 128
TOCCOA GA
30577-1402
US

V. Phone/Fax

Practice location:
  • Phone: 800-884-7850
  • Fax: 888-315-0747
Mailing address:
  • Phone: 800-884-7850
  • Fax: 888-315-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. DIANE O'TOOLE
Title or Position: OWNER
Credential:
Phone: 800-884-7850