Provider Demographics
NPI:1790229318
Name:ST. JOSEPH SATELLITE DIALYSIS CENTERS, LLC
Entity Type:Organization
Organization Name:ST. JOSEPH SATELLITE DIALYSIS CENTERS, LLC
Other - Org Name:ST. JOSEPH SATELLITE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-736-2700
Mailing Address - Street 1:1518 W LA VETA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4117
Mailing Address - Country:US
Mailing Address - Phone:714-285-9675
Mailing Address - Fax:714-285-9681
Practice Address - Street 1:1518 W LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4117
Practice Address - Country:US
Practice Address - Phone:714-285-9675
Practice Address - Fax:714-285-9681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
187376OtherBUSINESS LICENSE