Provider Demographics
NPI:1912592379
Name:NORTHSTAR TRANSPORTATION SERVICE LLC
Entity type:Organization
Organization Name:NORTHSTAR TRANSPORTATION SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:I
Authorized Official - Last Name:WOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-551-8355
Mailing Address - Street 1:360 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4238
Mailing Address - Country:US
Mailing Address - Phone:323-921-5074
Mailing Address - Fax:
Practice Address - Street 1:360 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4238
Practice Address - Country:US
Practice Address - Phone:323-921-5074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-07
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA6391873OtherDRIVER LICENSE