Basic Information
| Provider Information | |||||||||
| NPI: | 1760879415 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIBRO AT FREEHOLD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2328 10TH AVE N FL 3 | ||||||||
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| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334616606 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4345 US HIGHWAY 9 STE 28 | ||||||||
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| City: | FREEHOLD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077284206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324315300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2015 | ||||||||
| LastUpdateDate: | 04/21/2015 | ||||||||
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| AuthorizedOfficialLastName: | STOKES | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5613184455 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.