Provider Demographics
NPI:1700227964
Name:VIBRA HOSPITAL OF CHARLESTON LLC
Entity Type:Organization
Organization Name:VIBRA HOSPITAL OF CHARLESTON LLC
Other - Org Name:VIBRA HOSPITAL OF CHARLESTON-TCU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:T
Authorized Official - Last Name:FEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-591-5700
Mailing Address - Street 1:8081 ROYAL RIDGE PARKWAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2840
Mailing Address - Country:US
Mailing Address - Phone:489-713-5470
Mailing Address - Fax:469-713-0480
Practice Address - Street 1:1200 HOSPITAL DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3251
Practice Address - Country:US
Practice Address - Phone:843-375-4220
Practice Address - Fax:843-881-8147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC425405Medicare Oscar/Certification