Provider Demographics
NPI:1235133711
Name:VIBRANTCARE OUTPATIENT REHABILITATION OF CALIFORNIA INC
Entity Type:Organization
Organization Name:VIBRANTCARE OUTPATIENT REHABILITATION OF CALIFORNIA INC
Other - Org Name:VIBRANTCARE REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-782-1212
Mailing Address - Street 1:PO BOX 840343
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-0343
Mailing Address - Country:US
Mailing Address - Phone:916-789-8115
Mailing Address - Fax:916-773-1481
Practice Address - Street 1:2160 APPIAN WAY
Practice Address - Street 2:STE 101
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2524
Practice Address - Country:US
Practice Address - Phone:510-724-1248
Practice Address - Fax:510-724-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056803Medicare Oscar/Certification