Provider Demographics
NPI:1093903866
Name:VIBRANT HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:VIBRANT HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:972-816-9299
Mailing Address - Street 1:55 NOBLE CT STE 110
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6278
Mailing Address - Country:US
Mailing Address - Phone:972-816-9299
Mailing Address - Fax:972-772-2565
Practice Address - Street 1:3884 S SHILOH RD STE 118
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-4729
Practice Address - Country:US
Practice Address - Phone:903-885-3975
Practice Address - Fax:903-885-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011792251E00000X, 261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No251E00000XAgenciesHome Health