Provider Demographics
NPI:1730898362
Name:NEW VINTAGE CHURCH, INC.
Entity type:Organization
Organization Name:NEW VINTAGE CHURCH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PASTOR/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BARTELME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-400-8320
Mailing Address - Street 1:6626 W BELOIT RD
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2009
Mailing Address - Country:US
Mailing Address - Phone:414-400-8320
Mailing Address - Fax:
Practice Address - Street 1:6626 W BELOIT RD
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-2009
Practice Address - Country:US
Practice Address - Phone:414-400-8320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health