Healthcare Provider Details

I. General information

NPI: 1700221249
Provider Name (Legal Business Name): VIBRA HOSPITAL OF WESTERN MASSACHUSETTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HUNTOON MEMORIAL HWY
ROCHDALE MA
01542-1305
US

IV. Provider business mailing address

4499 ACUSHNET AVENUE
NEW BEDFORD MA
02745-4707
US

V. Phone/Fax

Practice location:
  • Phone: 508-892-4858
  • Fax: 508-892-4857
Mailing address:
  • Phone: 508-995-6900
  • Fax: 508-998-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateMA

VIII. Authorized Official

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