NPIMap

Organization Active NPI

Vibra Hospital of Fargo LLC

  • Long Term Care Hospital
  • Fargo, ND
National Provider Identifier
1508205741
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
Legal business name
VIBRA HOSPITAL OF FARGO LLC
Practice address
5225 23Rd Ave S FL 7
Fargo, ND 58104-7927
Phone
(701) 241-9099
Fax
(701) 241-9114
NPI assigned
Jun 20, 2013
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 ND Primary

Addresses

Primary practice location

5225 23Rd Ave S FL 7
Fargo, ND 58104-7927

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130814000731 ND Part A Provider - Hospital 8224270608 Practice locations: Fargo, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508205741. Details of each certification follow.

Hospital certification: CCN 352004

Legal name
VIBRA HOSPITAL OF FARGO LLC
Doing business as
VIBRA HOSPITAL OF FARGO
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Oct 2, 1998
Last certification
Apr 3, 2003
Beds
31
Ownership / control type
Private (for profit)
Most recent change of ownership
Sep 1, 2013 (1 total)
Organization structure
LLCProprietary
Incorporated
Apr 25, 2013 in DE
Enrollment address
5225 23Rd Ave S
FL 7
Fargo, ND 58104-7927
Other Hospital Practice Location
Hospital subgroups
Long-term

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Vibra Hospital of FargoCCN 352004 · All quality measures
Ownership
For profit
Certified
Oct 2, 1998
Medicare certification status
ActiveFrom the Provider of Services file
Beds
31

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D0994257Vibra Hospital of Fargo5225 23Rd Ave S, 7TH Floor, Fargo, ND 58104Certificate of waiverDec 9, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Kelly M Hollinger Individual Corporate Officer Mar 1, 2020
Vibra Management, LLC Organization, New York, NY LLC Other Sep 1, 2013
Credit Suisse Ag Organization, New York, NY LLC, Financial institution, For-profit 5% Or Greater Security Interest Jul 22, 2020 100%
David E Hauck Individual Corporate Officer Oct 4, 2018
Vibra Healthcare II, LLC Organization, Mechanicsburg, PA LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Sep 1, 2013 100%
Trisha J Niemuth Individual Corporate Officer Jan 1, 2022
Brad E Hollinger Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2013 77%
Corporate OfficerPresident Sep 1, 2013
VHF Tenant LLC Organization, Mechanicsburg, PA LLC 5% Or Greater Security Interest Jun 12, 2017 55%
Custer W Huseby Individual W-2 Managing EmployeeCeo Sep 1, 2013

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 4

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 6

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

NPI Registry JSON

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

{
    "created_epoch": "1371686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1508205741",
    "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": "5225 23RD AVE S FL 7",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047927",
            "telephone_number": "701-241-9099",
            "fax_number": "701-241-9114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRA HOSPITAL OF FARGO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-20",
        "last_updated": "2023-10-10",
        "certification_date": "2020-07-02",
        "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": "ND",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.