Provider Demographics
NPI:1144738303
Name:MODERN LUXE TRANSPORTATION INC
Entity Type:Organization
Organization Name:MODERN LUXE TRANSPORTATION INC
Other - Org Name:MODERN LUXE TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAVERICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SHABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-787-4200
Mailing Address - Street 1:PO BOX 250572
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-0572
Mailing Address - Country:US
Mailing Address - Phone:248-787-4200
Mailing Address - Fax:
Practice Address - Street 1:5562 HAMPSHIRE DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1129
Practice Address - Country:US
Practice Address - Phone:248-910-5733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)