Provider Demographics
NPI:1588009039
Name:VIBRA HOSPITAL OF WESTERN MASSACHUSETTS LLC
Entity Type:Organization
Organization Name:VIBRA HOSPITAL OF WESTERN MASSACHUSETTS LLC
Other - Org Name:VIBRA HOSPITAL OF WESTERN MASSACHUSETTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-591-5700
Mailing Address - Street 1:4499 ACUSHNET AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-4707
Mailing Address - Country:US
Mailing Address - Phone:508-995-6900
Mailing Address - Fax:508-998-5974
Practice Address - Street 1:1400 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-2550
Practice Address - Country:US
Practice Address - Phone:413-787-6700
Practice Address - Fax:413-787-6704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA222046Medicare Oscar/Certification