Provider Demographics
NPI:1497445027
Name:WONDERHILL FARM
Entity Type:Organization
Organization Name:WONDERHILL FARM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-830-0000
Mailing Address - Street 1:2800 CANEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHAPPELL HILL
Mailing Address - State:TX
Mailing Address - Zip Code:77426-5284
Mailing Address - Country:US
Mailing Address - Phone:979-830-0000
Mailing Address - Fax:
Practice Address - Street 1:2800 CANEY CREEK RD
Practice Address - Street 2:
Practice Address - City:CHAPPELL HILL
Practice Address - State:TX
Practice Address - Zip Code:77426-5284
Practice Address - Country:US
Practice Address - Phone:979-830-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy