Provider Demographics
NPI:1215117064
Name:5STARS MEDCALTRANS LLC
Entity type:Organization
Organization Name:5STARS MEDCALTRANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRIVER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAGWA
Authorized Official - Middle Name:ELFAKI
Authorized Official - Last Name:ABDELRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-237-7509
Mailing Address - Street 1:8227 S 52ND LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2847
Mailing Address - Country:US
Mailing Address - Phone:602-237-7509
Mailing Address - Fax:602-237-7509
Practice Address - Street 1:8227 S 52ND LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2847
Practice Address - Country:US
Practice Address - Phone:602-237-7509
Practice Address - Fax:602-237-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL1393856-1343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)