Healthcare Provider Details

I. General information

NPI: 1366912024
Provider Name (Legal Business Name): EXQUISITE EVENTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 E 166TH ST
SOUTH HOLLAND IL
60473-2336
US

IV. Provider business mailing address

654 E 166TH ST
SOUTH HOLLAND IL
60473-2336
US

V. Phone/Fax

Practice location:
  • Phone: 773-787-5447
  • Fax:
Mailing address:
  • Phone: 773-787-5447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: TULESHA MARION PETERS
Title or Position: OFFICER
Credential:
Phone: 773-787-5447