Provider Demographics
NPI:1073888699
Name:SATELLITE HEALTHCARE SILVER CREEK LLC
Entity Type:Organization
Organization Name:SATELLITE HEALTHCARE SILVER CREEK LLC
Other - Org Name:SATELLITE HEALTHCARE SILVER CREEK
Other - Org Type:Doing Business As
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:408-754-3400
Mailing Address - Fax:650-625-6007
Practice Address - Street 1:1620 E CAPITOL EXPY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1860
Practice Address - Country:US
Practice Address - Phone:408-754-3400
Practice Address - Fax:408-274-2810
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATELLITE HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-15
Last Update Date:2016-12-29
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
CACLR00343525OtherCLIA-STATE
CA550002245OtherSTATE OF CALIFORNIA
CA1073888699Medicaid
CA05D2050728OtherCLIA-CMS
CA550002245OtherSTATE OF CALIFORNIA