Healthcare Provider Details

I. General information

NPI: 1336951037
Provider Name (Legal Business Name): STELLAR PERFORMANCE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 BOULDER CREEK RD
RICHMOND VA
23225-4165
US

IV. Provider business mailing address

PO BOX 14142
RICHMOND VA
23225-9089
US

V. Phone/Fax

Practice location:
  • Phone: 804-489-9607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MR. ANTONIO JONES JR.
Title or Position: OWNER
Credential:
Phone: 804-489-9607