Provider Demographics
NPI:1780811901
Name:TUMBLEDOWN FARM
Entity type:Organization
Organization Name:TUMBLEDOWN FARM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VITTORIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRUNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-327-1317
Mailing Address - Street 1:329 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04410-3320
Mailing Address - Country:US
Mailing Address - Phone:207-327-1317
Mailing Address - Fax:
Practice Address - Street 1:329 MAIN RD
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:ME
Practice Address - Zip Code:04410-3320
Practice Address - Country:US
Practice Address - Phone:207-327-1317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization