Healthcare Provider Details

I. General information

NPI: 1508552696
Provider Name (Legal Business Name): PRODUCTION FARM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 BROADWAY ST
SHEBOYGAN FALLS WI
53085-1544
US

IV. Provider business mailing address

2668 STONEGATE DR
SUAMICO WI
54313-8123
US

V. Phone/Fax

Practice location:
  • Phone: 920-305-6313
  • Fax:
Mailing address:
  • Phone: 920-288-1965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JAY PATRICK MUSE SEYMOUR
Title or Position: CFO/MANAGING DIRECTOR
Credential:
Phone: 920-305-6313