Healthcare Provider Details

I. General information

NPI: 1356491534
Provider Name (Legal Business Name): VIBRA HOSPITAL OF NORTHWESTERN INDIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/12/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9509 GEORGIA ST
CROWN POINT IN
46307-6518
US

IV. Provider business mailing address

PO BOX 26657
FRESNO CA
93729-6657
US

V. Phone/Fax

Practice location:
  • Phone: 219-472-2200
  • Fax: 219-472-2148
Mailing address:
  • Phone: 559-892-2500
  • Fax: 559-892-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number100121311
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. BRAD EUGENE HOLLINGER
Title or Position: PRESIDENT
Credential:
Phone: 717-591-5700