Provider Demographics
NPI:1215616784
Name:VIBRANCE SCREENING AND WELLNESS LLC
Entity type:Organization
Organization Name:VIBRANCE SCREENING AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAUNDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-386-7719
Mailing Address - Street 1:1304 SUNSET BLVD # 1161
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-5914
Mailing Address - Country:US
Mailing Address - Phone:803-386-7719
Mailing Address - Fax:
Practice Address - Street 1:223 CALICO CT
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29172-2608
Practice Address - Country:US
Practice Address - Phone:803-383-5818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty