NPIMap

Organization Active NPI

Vibra of Southeastern Michigan LLC

Doing business as Vibra of Southeastern Michigan

  • Long Term Care Hospital
  • Lincoln Park, MI
National Provider Identifier
1508027624
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
License
820130 Issued in MI
Legal business name
VIBRA OF SOUTHEASTERN MICHIGAN LLC
Doing business as
Vibra of Southeastern Michigan
Practice address
26400 West Outer Dr
Lincoln Park, MI 48146-2088
Phone
(313) 594-6000
Fax
(313) 594-6252
NPI assigned
Jun 20, 2008
Last updated
Oct 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Brad Eugene Hollinger
Title
President
Phone
(717) 591-5700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X 820130 MI Primary

Addresses

Primary practice location

26400 West Outer Dr
Lincoln Park, MI 48146-2088

Mailing address

PO Box 26657
Fresno, CA 93729-6657
Phone (559) 892-2500

Other identifiers 1

IdentifierTypeStateIssuer
302715477MedicaidMI

Other names 1

  • Vibra of Southeastern Michigan Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080527000468 MI Part A Provider - Hospital 0547339996 1 other NPI on this enrollment
Practice locations: Detroit, MI; Taylor, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508027624. Details of each certification follow.

Hospital certification: CCN 232019

Legal name
VIBRA OF SOUTHEASTERN MICHIGAN LLC
Doing business as
VIBRA HOSPITAL OF SOUTHEASTERN MICHIGAN - TAYLOR CAMPUS
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Jul 1, 1991
Last certification
Oct 7, 2016
Beds
220
Ownership / control type
Private (for profit)
Most recent change of ownership
May 1, 1998 (1 total)
Organization structure
LLCProprietary
Incorporated
Jan 11, 2008 in MI
Enrollment address
10000 Telegraph Rd
Taylor, MI 48180-3330
Main/Primary Hospital Location
Hospital subgroups
Long-term

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Vibra Hospital of Southeastern Mi-Taylor CampusCCN 232019 · All quality measures
Ownership
For profit
Certified
Jul 1, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Beds
220

National Provider Directory

National Provider Directory
Tax ID family
Vibra of Southeastern LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Oakwood Healthcare Inc Organization, Taylor, MI Corporation, Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Apr 16, 2019
James a Diebold Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2009 5.16%
Kelly M Hollinger Individual Corporate OfficerVice President Mar 1, 2020
Vibra Management, LLC Organization, Mechanicsburg, PA LLC, Management services company, For-profit Operational/Managerial Control May 22, 2008
Susan Manzella Individual W-2 Managing EmployeeCeo Sep 1, 2022
David E Hauck Individual Corporate OfficerTreasurer Oct 4, 2018
Hollinger Holding Company LLC Organization, Mechanicsburg, PA LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2009 51.6%
Oakwood Enterprises Inc Organization, Dearborn, MI For-profit 5% Or Greater Direct Ownership Interest Jan 31, 2014 40%
Vibra Healthcare, LLC Organization, Mechanicsburg, PA LLC, For-profit 5% Or Greater Direct Ownership Interest May 22, 2008 60%
Brad E Hollinger Individual 5% Or Greater Indirect Ownership Interest May 22, 2008 42.83%
Corporate OfficerPresident Jan 11, 2008
MPT of Detroit LP Organization, Birmingham, AL For-profit 5% Or Greater Security Interest May 22, 2008 44.4%
Other May 22, 2008
Robert Ingram Individual W-2 Managing EmployeeCco Apr 22, 2015
Midcap Funding IV Trust Organization, Bethesda, MD Financial institution 5% Or Greater Security Interest Feb 23, 2023 89%

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 16

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1508027624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26657",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937296657",
            "telephone_number": "559-892-2500",
            "fax_number": "559-892-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26400 WEST OUTER DR",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481462088",
            "telephone_number": "313-594-6000",
            "fax_number": "313-594-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRA OF SOUTHEASTERN MICHIGAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-20",
        "last_updated": "2023-10-10",
        "status": "A",
        "authorized_official_last_name": "HOLLINGER",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "717-591-5700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "MI",
            "license": "820130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "302715477",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vibra of Southeastern Michigan",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vibra of Southeastern Michigan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lincoln Park, MI

Sources for this page

Verify at the official NPI Registry.