Provider Demographics
NPI:1932118452
Name:TBN, LLC
Entity Type:Organization
Organization Name:TBN, LLC
Other - Org Name:NEW RICHMOND MEADOWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HALBLEIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-877-2411
Mailing Address - Street 1:505 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1524
Mailing Address - Country:US
Mailing Address - Phone:715-246-6851
Mailing Address - Fax:715-246-1065
Practice Address - Street 1:505 W 8TH ST
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1524
Practice Address - Country:US
Practice Address - Phone:715-246-6851
Practice Address - Fax:715-246-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WINOT YET ISSUED314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI525019Medicare ID - Type Unspecified