Provider Demographics
NPI:1164767836
Name:SATELLITE HEALTHCARE INC
Entity Type:Organization
Organization Name:SATELLITE HEALTHCARE INC
Other - Org Name:SATELLITE DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-404-3600
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:707-303-2040
Mailing Address - Fax:650-625-6008
Practice Address - Street 1:6265 COMMERCE BLVD
Practice Address - Street 2:SUITE 156
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-6300
Practice Address - Country:US
Practice Address - Phone:707-303-2040
Practice Address - Fax:707-586-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2023-01-11
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
CA1164767836Medicaid
CA550002412OtherSTATE LICENSE
CA1164767836Medicaid