Provider Demographics
NPI:1679075972
Name:VIBRALIFE OF KATY, LLC
Entity Type:Organization
Organization Name:VIBRALIFE OF KATY, LLC
Other - Org Name:VIBRALIFE OF KATY REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-591-5704
Mailing Address - Street 1:4600 LENA DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4904
Mailing Address - Country:US
Mailing Address - Phone:717-591-5704
Mailing Address - Fax:
Practice Address - Street 1:1222 PARK WEST GREEN DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3654
Practice Address - Country:US
Practice Address - Phone:717-591-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility