Healthcare Provider Details

I. General information

NPI: 1871151068
Provider Name (Legal Business Name): 5 STAR ELITE SERVICES. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 WIRTZ RD
WIRTZ VA
24184-4313
US

IV. Provider business mailing address

5010 WIRTZ RD
WIRTZ VA
24184-4313
US

V. Phone/Fax

Practice location:
  • Phone: 540-719-1405
  • Fax:
Mailing address:
  • Phone: 540-719-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ANGELA TONEY
Title or Position: OWNER
Credential:
Phone: 540-521-5136