NPIMap

Organization Active NPI

Vibrantcare Outpatient Rehabilitation of California Inc

Doing business as VibrantCare Rehabilitation

  • Physical Therapy Clinic/Center
  • Manteca, CA
National Provider Identifier
1760486120
Registry record updated Nov 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
VIBRANTCARE OUTPATIENT REHABILITATION OF CALIFORNIA INC
Doing business as
VibrantCare Rehabilitation
Practice address
965 E Yosemite Ave
Suite 14
Manteca, CA 95336-5938
Phone
(209) 823-3736
Fax
(209) 823-0267
NPI assigned
Jun 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2023

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

Authorized official

Name
Mr. David Smith
Title
Ceo
Phone
(916) 782-1212

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

965 E Yosemite Ave
Suite 14
Manteca, CA 95336-5938

Mailing address

PO Box 840343
Los Angeles, CA 90084-0343
Phone (916) 789-8115

Other names 1

  • VibrantCare Rehabilitation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050314001148 CA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 9234046962 Practice locations: Manteca, CA; Tracy, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760486120. Details of each certification follow.

  • CCN 056841 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 056841

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
VIBRANTCARE OUTPATIENT REHABILITATION OF CA INC
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
May 22, 1997
Last certification
Apr 6, 2020
Ownership / control type
Proprietary
Most recent change of ownership
Oct 31, 2001
Facility address
965 East Yosemite, Suite 14
Manteca, CA 95336

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Vibrantcare Outpatient Rehabilitation of California Inc19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Locations

2901 K St
Ste 170
Sacramento, CA 95816
Phone (916) 220-5559

1930 W Grant Line Rd
Tracy, CA 95376
Phone (209) 833-9400

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700611200000",
    "number": "1760486120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840343",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900840343",
            "telephone_number": "916-789-8115",
            "fax_number": "916-773-1481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 E YOSEMITE AVE",
            "address_2": "SUITE 14",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953365938",
            "telephone_number": "209-823-3736",
            "fax_number": "209-823-0267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRANTCARE OUTPATIENT REHABILITATION OF CALIFORNIA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2023-11-22",
        "certification_date": "2023-11-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-782-1212",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VibrantCare Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "VibrantCare Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manteca, CA

Sources for this page

Verify at the official NPI Registry.