Provider Demographics
NPI:1437733391
Name:TBI RESIDENTIAL REHAB, LLC
Entity Type:Organization
Organization Name:TBI RESIDENTIAL REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-361-1389
Mailing Address - Street 1:3834 WABEEK LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1258
Mailing Address - Country:US
Mailing Address - Phone:248-361-1389
Mailing Address - Fax:248-355-5801
Practice Address - Street 1:63 WALTONSHIRE CT
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1100
Practice Address - Country:US
Practice Address - Phone:248-732-7807
Practice Address - Fax:248-732-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities