Healthcare Provider Details

I. General information

NPI: 1053103358
Provider Name (Legal Business Name): SBS LUXE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 06/02/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 YELLOWSTONE WAY
PROVIDENCE VILLAGE TX
76227-5629
US

IV. Provider business mailing address

PO BOX 90
AUBREY TX
76227-0249
US

V. Phone/Fax

Practice location:
  • Phone: 469-404-2277
  • Fax:
Mailing address:
  • Phone: 469-404-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: SHARUNDOLYN B SHAW
Title or Position: OWNER
Credential:
Phone: 469-404-2277