Provider Demographics
NPI:1043834914
Name:VIBRANT SCL, LLC
Entity type:Organization
Organization Name:VIBRANT SCL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIT
Authorized Official - Middle Name:TYHE
Authorized Official - Last Name:BALOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-423-9752
Mailing Address - Street 1:1776 22ND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1444
Mailing Address - Country:US
Mailing Address - Phone:515-423-9752
Mailing Address - Fax:515-465-1233
Practice Address - Street 1:1776 22ND ST STE 201
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1444
Practice Address - Country:US
Practice Address - Phone:515-423-9752
Practice Address - Fax:515-465-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care