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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