Healthcare Provider Details

I. General information

NPI: 1528203049
Provider Name (Legal Business Name): VIBRA HOSPITAL OF MAHONING VALLEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8049 SOUTH AVE
BOARDMAN OH
44512-6154
US

IV. Provider business mailing address

5 EAST RIVER PARK PLACE E #460
FRESNO CA
93720-1560
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-5021
  • Fax: 330-726-5053
Mailing address:
  • Phone: 559-892-2500
  • Fax: 559-892-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1428
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number1428
License Number StateOH

VIII. Authorized Official

Name: MR. CLINT T. FEGAN
Title or Position: SEC/TREAS
Credential:
Phone: 717-591-5700