Provider Demographics
NPI:1255026431
Name:EXCLUSIVELY YOURZ WIGTIQUE LLC
Entity type:Organization
Organization Name:EXCLUSIVELY YOURZ WIGTIQUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-816-4225
Mailing Address - Street 1:2280 E 73RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-4828
Mailing Address - Country:US
Mailing Address - Phone:216-816-4225
Mailing Address - Fax:
Practice Address - Street 1:2280 E 73RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4828
Practice Address - Country:US
Practice Address - Phone:216-816-4225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care