Provider Demographics
NPI:1851164214
Name:WHARTON ENTERPRISES LTD
Entity type:Organization
Organization Name:WHARTON ENTERPRISES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SHAREHOLDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:F
Authorized Official - Last Name:WHARTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:618-889-3220
Mailing Address - Street 1:PO BOX 1191
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-7691
Mailing Address - Country:US
Mailing Address - Phone:618-889-3220
Mailing Address - Fax:618-992-2345
Practice Address - Street 1:106 S VICKSBURG ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1930
Practice Address - Country:US
Practice Address - Phone:618-992-2322
Practice Address - Fax:618-992-2345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHARTON ENTERPRISES LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1053709519Medicaid
IL1790564383Medicaid
IL1548043946Medicaid