Provider Demographics
NPI:1487688008
Name:VIBRANTCARE OUTPATIENT REHABILITATION OF CALIFORNIA, INC.
Entity Type:Organization
Organization Name:VIBRANTCARE OUTPATIENT REHABILITATION OF CALIFORNIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-789-8115
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:
Practice Address - Street 1:3000 W MACARTHUR BLVD STE 600
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6982
Practice Address - Country:US
Practice Address - Phone:717-975-4503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
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
CA556575Medicare Oscar/Certification