Provider Demographics
NPI:1306314034
Name:FIVE-STAR FAMILY TRANSPORTATION
Entity type:Organization
Organization Name:FIVE-STAR FAMILY TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-455-5344
Mailing Address - Street 1:7950 SOUTHEASTERN AVE UNIT 39148
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-3908
Mailing Address - Country:US
Mailing Address - Phone:317-643-2375
Mailing Address - Fax:
Practice Address - Street 1:3118 DANUBE WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-9289
Practice Address - Country:US
Practice Address - Phone:317-629-5558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)