Healthcare Provider Details

I. General information

NPI: 1437733391
Provider Name (Legal Business Name): TBI RESIDENTIAL REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 WALTONSHIRE CT
ROCHESTER HILLS MI
48309-1100
US

IV. Provider business mailing address

3834 WABEEK LAKE DR E
BLOOMFIELD HILLS MI
48302-1258
US

V. Phone/Fax

Practice location:
  • Phone: 248-732-7807
  • Fax: 248-732-7352
Mailing address:
  • Phone: 248-361-1389
  • Fax: 248-355-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. NINA LANG
Title or Position: SOLE MEMBER
Credential:
Phone: 248-361-1389