Provider Demographics
NPI:1295878536
Name:SATELLITE WELLBOUND OF HOUSTON LLC
Entity type:Organization
Organization Name:SATELLITE WELLBOUND OF HOUSTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEL BENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-404-3618
Mailing Address - Street 1:300 SANTANA ROW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2423
Mailing Address - Country:US
Mailing Address - Phone:650-404-3655
Mailing Address - Fax:650-625-6007
Practice Address - Street 1:7505 MAIN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4520
Practice Address - Country:US
Practice Address - Phone:713-799-9344
Practice Address - Fax:713-795-0574
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLBOUND LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-15
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8556OtherSTATE OF TEXAS
TX2158339-01Medicaid
TX8556OtherSTATE OF TEXAS