Provider Demographics
NPI:1306595236
Name:TIMBER WELLNESS LLC
Entity type:Organization
Organization Name:TIMBER WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-930-4014
Mailing Address - Street 1:7881 W CHARLESTON BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8327
Mailing Address - Country:US
Mailing Address - Phone:702-508-2153
Mailing Address - Fax:702-508-2435
Practice Address - Street 1:13770 FRONTIER CT
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4810
Practice Address - Country:US
Practice Address - Phone:702-848-2256
Practice Address - Fax:702-485-6746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1487181558Medicaid