Provider Demographics
NPI:1194177360
Name:EXCLUSIVE SERVICES
Entity type:Organization
Organization Name:EXCLUSIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY RAWLS
Authorized Official - Middle Name:MSW, LICDC
Authorized Official - Last Name:07
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICDC
Authorized Official - Phone:513-827-9273
Mailing Address - Street 1:11134 LUSCHEK DR
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2434
Mailing Address - Country:US
Mailing Address - Phone:513-827-9273
Mailing Address - Fax:
Practice Address - Street 1:11134 LUSCHEK DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-2434
Practice Address - Country:US
Practice Address - Phone:513-827-9273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0064132Medicaid
OHCL02255465003OtherOHIO PHARMACY BOARD LICENSE
OH0064132Medicaid