Provider Demographics
NPI:1821536319
Name:VIBRALIFE OF EL PASO LLC
Entity Type:Organization
Organization Name:VIBRALIFE OF EL PASO LLC
Other - Org Name:VIBRALIFE OF EL PASO REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
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 1:4550 LENA DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4922
Mailing Address - Country:US
Mailing Address - Phone:717-591-5700
Mailing Address - Fax:
Practice Address - Street 1:3421 JOE BATTLE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2638
Practice Address - Country:US
Practice Address - Phone:915-599-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility