Provider Demographics
NPI:1639426091
Name:NEW VISION WILDERNESS
Entity Type:Organization
Organization Name:NEW VISION WILDERNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-780-1780
Mailing Address - Street 1:1350 14TH AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-1990
Mailing Address - Country:US
Mailing Address - Phone:262-780-1780
Mailing Address - Fax:262-780-1781
Practice Address - Street 1:1350 14TH AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-1990
Practice Address - Country:US
Practice Address - Phone:262-780-1780
Practice Address - Fax:262-780-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-04
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp