Provider Demographics
NPI:1699192203
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-CENTRAL CAMPUS
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 1:111 HUNTOON MEMORIAL HWY
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ROCHDALE
Practice Address - State:MA
Practice Address - Zip Code:01542-1305
Practice Address - Country:US
Practice Address - Phone:508-892-6000
Practice Address - Fax:508-892-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22204600Medicare Oscar/Certification