Healthcare Provider Details

I. General information

NPI: 1427225267
Provider Name (Legal Business Name): FIVE STAR FA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 HICKMAN CT
CLIVE IA
50325-5330
US

IV. Provider business mailing address

10200 HICKMAN CT
CLIVE IA
50325-5330
US

V. Phone/Fax

Practice location:
  • Phone: 515-331-4613
  • Fax: 515-331-0521
Mailing address:
  • Phone: 515-331-4613
  • Fax: 515-331-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: MR. SHANE SONBERG
Title or Position: PRESIDENT
Credential:
Phone: 515-331-4613