Provider Demographics
NPI:1265625453
Name:GILMAN CARE CENTER LLC
Entity type:Organization
Organization Name:GILMAN CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER, LLC
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:NHA
Authorized Official - Phone:715-877-2411
Mailing Address - Street 1:600 WEST HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:GILMAN
Mailing Address - State:WI
Mailing Address - Zip Code:54433
Mailing Address - Country:US
Mailing Address - Phone:715-447-8217
Mailing Address - Fax:715-447-5775
Practice Address - Street 1:600 WEST HICKORY ST
Practice Address - Street 2:
Practice Address - City:GILMAN
Practice Address - State:WI
Practice Address - Zip Code:54433
Practice Address - Country:US
Practice Address - Phone:715-447-8217
Practice Address - Fax:715-447-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WITO BE ISSUED314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WITO BE ISSUEDMedicaid
WITO BE ISSUEDMedicaid