MEDICARE: VIBRANT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		FL

General Provider Information

NPI Number	:	1649465899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIBRANT INC

Provider Business Mailing Address
First Line	:	610 NW 183RD ST
Second Line	:	#205
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4472
Country	:	US
Telephone Number	:	305-651-4222
Fax Number	:	305-651-4008

Provider Business Practice Location Address
First Line	:	610 NW 183RD ST
Second Line	:	#205
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4472
Country	:	US
Telephone Number	:	305-651-4222
Fax Number	:	305-651-4008

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. DIAHANN DENISE HARRIS
Credential	:
Telephone Number	:	305-651-4222

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	01/29/2008

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