Provider Demographics
NPI:1801025127
Name:CROWN OF GLORY TAILORED TO YOU WIGS
Entity Type:Organization
Organization Name:CROWN OF GLORY TAILORED TO YOU WIGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:CORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-459-2140
Mailing Address - Street 1:370 E THORNTON ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1747
Mailing Address - Country:US
Mailing Address - Phone:330-459-2140
Mailing Address - Fax:
Practice Address - Street 1:370 E THORNTON ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1747
Practice Address - Country:US
Practice Address - Phone:330-459-2140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH200917501226302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization