Provider Demographics
NPI:1912688912
Name:VIBRANCE HOME CARE LLC
Entity type:Organization
Organization Name:VIBRANCE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RIYAK
Authorized Official - Middle Name:ABDI
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-512-1004
Mailing Address - Street 1:1066 COUNTY HIGHWAY 10 UNIT 405
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2668
Mailing Address - Country:US
Mailing Address - Phone:612-512-1004
Mailing Address - Fax:
Practice Address - Street 1:1066 COUNTY HIGHWAY 10 UNIT 405
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-2668
Practice Address - Country:US
Practice Address - Phone:612-512-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care