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General NPI Number Information
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NPI Number | 1366005019
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Entity Type | Organization
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Legal Business Name | TIM HALBROOK BUILDERS, INC
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Dates
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Enumeration Date | 04/18/2019
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Last Update Date | 04/18/2019
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Provider Practice Location Address
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Address Line | 3681 MONROE RD
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City | DE PERE
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State | WI
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Zip | 54115-8355
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Country | US
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Telephone | 920-336-1413
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Fax |
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Provider Business Mailing Address
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Address Line | 3681 MONROE RD
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City | DE PERE
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State | WI
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Zip | 54115-8355
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY HALBROOK
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Credential |
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Telephone | 920-336-1413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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