Provider Demographics
NPI:1649465899
Name:VIBRANT INC
Entity type:Organization
Organization Name:VIBRANT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIAHANN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-651-4222
Mailing Address - Street 1:610 NW 183RD ST
Mailing Address - Street 2:#205
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4472
Mailing Address - Country:US
Mailing Address - Phone:305-651-4222
Mailing Address - Fax:305-651-4008
Practice Address - Street 1:610 NW 183RD ST
Practice Address - Street 2:#205
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4472
Practice Address - Country:US
Practice Address - Phone:305-651-4222
Practice Address - Fax:305-651-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health