Organization
VIBRA HOSPITAL OF SAN BERNARDINO, LLC
Active
Other names
Ballard Rehabilitation Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAD EUGENE HOLLINGER (PRESIDENT)
(717) 591-5700
Entity
Organization
Contact information
Practice address
1760 W 16TH ST, SAN BERNARDINO, CA 92411-1160
(909) 473-1200
(909) 473-1276
Mailing address
PO BOX 26657, FRESNO, CA 93729-6657
(559) 892-2500
(559) 892-2444
Taxonomy
Speciality
Code
Description
License number
State
283X00000X
Rehabilitation Hospital
Primary
240000502
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120321000
DEPT OF LABOR
—
05
—
1497748081
—
CA
01
—
ZZZH3608Z
BLUE SHIELD
—
Enumeration date
08/29/2005
Last updated
10/10/2023
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