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Organization
VINTAGE VIEW FARM INC
Active
Organization
VINTAGE VIEW FARM INC
Active
Other names
Vintage View Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM WALLOW (MANAGING PRINCIPAL)
(262) 242-1110
Entity
Organization
Contact information
Practice address
7230 W HIGHLAND RD, MEQUON, WI 53092-1002
(262) 242-1110
(262) 236-9589
Mailing address
7230 W HIGHLAND RD, MEQUON, WI 53092-1002
(262) 242-1110
(262) 236-9589
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
305R00000X
Preferred Provider Organization
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0100
NA
WI
Enumeration date
10/22/2014
Last updated
12/07/2015
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