Provider Demographics
NPI:1427737386
Name:VIBRANT LIFE HOME HEALTH INC
Entity type:Organization
Organization Name:VIBRANT LIFE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOLKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-541-5550
Mailing Address - Street 1:237 W BONITA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3048
Mailing Address - Country:US
Mailing Address - Phone:909-541-5550
Mailing Address - Fax:909-541-5544
Practice Address - Street 1:237 W BONITA AVE STE C
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3048
Practice Address - Country:US
Practice Address - Phone:909-541-5550
Practice Address - Fax:909-541-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health