Provider Demographics
NPI:1528957693
Name:SAFERIDE STAR LLC
Entity type:Organization
Organization Name:SAFERIDE STAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHADIR
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAYISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-272-8789
Mailing Address - Street 1:6796 S PIGEONBERRY PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-5149
Mailing Address - Country:US
Mailing Address - Phone:520-272-8789
Mailing Address - Fax:
Practice Address - Street 1:6796 S PIGEONBERRY PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85756-5149
Practice Address - Country:US
Practice Address - Phone:520-272-8789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)