Provider Demographics
NPI:1922396225
Name:W EQUINE ESCAPE LTD
Entity type:Organization
Organization Name:W EQUINE ESCAPE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:618-559-1960
Mailing Address - Street 1:7230 STATE ROUTE 152
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-4330
Mailing Address - Country:US
Mailing Address - Phone:618-559-1960
Mailing Address - Fax:618-542-3353
Practice Address - Street 1:7230 STATE ROUTE 152
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-4330
Practice Address - Country:US
Practice Address - Phone:618-559-1960
Practice Address - Fax:618-542-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation