Healthcare Provider Details

I. General information

NPI: 1285456798
Provider Name (Legal Business Name): ELITE LUXE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2024
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 SAWDUST RD # 3184
SPRING TX
77380-2242
US

IV. Provider business mailing address

4274 MEDINA RIVER LOOP
SPRING TX
77386-1543
US

V. Phone/Fax

Practice location:
  • Phone: 346-740-9557
  • Fax:
Mailing address:
  • Phone: 346-740-9557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name: DAIRA SHERROD
Title or Position: LAB DIRECTOR
Credential:
Phone: 346-740-9557