Provider Demographics
NPI:1104261668
Name:VIBRA HOSPITAL OF PEORIA LLC
Entity type:Organization
Organization Name:VIBRA HOSPITAL OF PEORIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-591-5700
Mailing Address - Street 1:4550 LENA DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4922
Mailing Address - Country:US
Mailing Address - Phone:717-591-5700
Mailing Address - Fax:717-591-2301
Practice Address - Street 1:500 W ROMEO B GARRETT AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2301
Practice Address - Country:US
Practice Address - Phone:309-680-1500
Practice Address - Fax:309-680-1486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital