Healthcare Provider Details

I. General information

NPI: 1578904322
Provider Name (Legal Business Name): VIBRA HOSPITAL OF CHARLESTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 10/10/2023
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HOSPITAL DR 3RD FLOOR
MT PLEASANT SC
29464-3251
US

IV. Provider business mailing address

PO BOX 26657
FRESNO CA
93729-6657
US

V. Phone/Fax

Practice location:
  • Phone: 843-375-4000
  • Fax: 843-375-4098
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 NumberHTL-0764
License Number StateSC

VIII. Authorized Official

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