Provider Demographics
NPI:1962444935
Name:8451 PEARL STREET OPERATING COMPANY LLC
Entity Type:Organization
Organization Name:8451 PEARL STREET OPERATING COMPANY LLC
Other - Org Name:VIBRA PSYCHIATRIC HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:171-591-5700
Mailing Address - Street 1:4550 LENA DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4922
Mailing Address - Country:US
Mailing Address - Phone:717-591-5709
Mailing Address - Fax:717-591-5710
Practice Address - Street 1:8451 PEARL ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4804
Practice Address - Country:US
Practice Address - Phone:303-288-3000
Practice Address - Fax:303-286-1253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO010403283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36632040Medicaid
NM58404015Medicaid
CO36632040Medicaid
CO064018Medicare Oscar/Certification