Healthcare Provider Details

I. General information

NPI: 1164863676
Provider Name (Legal Business Name): VIBRA HOSPITAL OF RICHMOND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 EDWARD HOLLAND DR
RICHMOND VA
23230-2519
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 804-204-1537
  • Fax: 804-254-1972
Mailing address:
  • Phone: 559-892-2500
  • Fax: 559-892-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License NumberH1932
License Number StateVA

VIII. Authorized Official

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