Provider Demographics
NPI:1730110578
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:95128-2424
Mailing Address - Country:US
Mailing Address - Phone:650-377-0888
Mailing Address - Fax:650-404-3601
Practice Address - Street 1:2000 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1805
Practice Address - Country:US
Practice Address - Phone:650-377-0888
Practice Address - Fax:650-358-3903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATELLITE HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-06
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000630261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC02819GMedicaid
CA052819Medicare Oscar/Certification