Healthcare Provider Details

I. General information

NPI: 1235043423
Provider Name (Legal Business Name): VIBRANT LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2592 SUNNYVIEW RD NE
SALEM OR
97301-8114
US

IV. Provider business mailing address

2592 SUNNYVIEW RD NE
SALEM OR
97301-8114
US

V. Phone/Fax

Practice location:
  • Phone: 971-273-6015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAMUEL NOACK
Title or Position: OWNER
Credential:
Phone: 971-273-6015