Provider Demographics
NPI:1164863676
Name:VIBRA HOSPITAL OF RICHMOND LLC
Entity Type:Organization
Organization Name:VIBRA HOSPITAL OF RICHMOND LLC
Other - Org Name:VIBRA HOSPITAL OF RICHMOND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:T
Authorized Official - Last Name:FEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-591-5700
Mailing Address - Street 1:5 E RIVER PARK PLACE E #460
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1560
Mailing Address - Country:US
Mailing Address - Phone:559-892-2500
Mailing Address - Fax:559-892-2442
Practice Address - Street 1:2220 EDWARD HOLLAND DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2519
Practice Address - Country:US
Practice Address - Phone:804-204-1537
Practice Address - Fax:804-254-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1932282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA492009Medicare Oscar/Certification