Provider Demographics
NPI:1053936450
Name:FIVE STAR ELITE TRANSPORTATION SERVICES LLC
Entity type:Organization
Organization Name:FIVE STAR ELITE TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-455-3433
Mailing Address - Street 1:9051 MANSFIELD RD STE E3
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2680
Mailing Address - Country:US
Mailing Address - Phone:318-425-9086
Mailing Address - Fax:318-716-3378
Practice Address - Street 1:9051 MANSFIELD RD STE E3
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2680
Practice Address - Country:US
Practice Address - Phone:318-425-9086
Practice Address - Fax:318-716-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)