Healthcare Provider Details

I. General information

NPI: 1306337993
Provider Name (Legal Business Name): VIBRANT HEALTH CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2018
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14545 FRIAR ST STE 210
VAN NUYS CA
91411-2399
US

IV. Provider business mailing address

14545 FRIAR ST STE 210
VAN NUYS CA
91411-2399
US

V. Phone/Fax

Practice location:
  • Phone: 818-935-5409
  • Fax: 818-405-0695
Mailing address:
  • Phone: 818-935-5409
  • Fax: 818-405-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EDGAR SARGSYAN
Title or Position: CEO
Credential:
Phone: 818-935-5409