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General NPI Number Information
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NPI Number | 1952818031
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Entity Type | Organization
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Legal Business Name | 5 STAR RICCO LLC
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 10938 RUNNING BROOK RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46234-7743
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Country | US
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Telephone | 317-989-5507
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Fax |
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Provider Business Mailing Address
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Address Line | 10938 RUNNING BROOK RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46234-7743
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Country | US
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Telephone | 317-989-5507
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICCO MCCLAREN
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Credential |
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Telephone | 317-989-5507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State | IN
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