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General NPI Number Information
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NPI Number | 1093903866
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Entity Type | Organization
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Legal Business Name | VIBRANT HOME HEALTH CARE, INC.
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 3884 S SHILOH RD STE 118
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City | GARLAND
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State | TX
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Zip | 75041-4729
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Country | US
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Telephone | 903-885-3975
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Fax | 903-885-3978
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Provider Business Mailing Address
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Address Line | 55 NOBLE CT STE 110
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City | ROCKWALL
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State | TX
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Zip | 75032-6278
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Country | US
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Telephone | 972-816-9299
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Fax | 972-772-2565
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Authorized Official
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Title or Position | ADMIN/OWNER
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Name | MR. BEN E. WALLER IV
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Credential |
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Telephone | 972-816-9299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 011792
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 011792
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License Number State | TX
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