Healthcare Provider Details

I. General information

NPI: 1780811901
Provider Name (Legal Business Name): TUMBLEDOWN FARM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 MAIN RD
BRADFORD ME
04410-3320
US

IV. Provider business mailing address

329 MAIN RD
BRADFORD ME
04410-3320
US

V. Phone/Fax

Practice location:
  • Phone: 207-327-1317
  • Fax:
Mailing address:
  • Phone: 207-327-1317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. VITTORIA J BRUNI
Title or Position: OWNER
Credential:
Phone: 207-327-1317