Provider Demographics
NPI:1275681348
Name:WELLBOUND OF MERCER LLC
Entity Type:Organization
Organization Name:WELLBOUND OF MERCER LLC
Other - Org Name:WELLBOUND OF MERCER
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:650-404-3657
Mailing Address - Fax:650-625-6007
Practice Address - Street 1:3836 QUAKERBRIDGE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1006
Practice Address - Country:US
Practice Address - Phone:609-586-5001
Practice Address - Fax:609-586-1862
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLBOUND LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-08
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
NJ192821Medicaid
NJ24145OtherSTATE OF NEW JERSEY
NJ312591Medicare Oscar/Certification