Provider Demographics
NPI:1649542960
Name:SATELLITE DIALYSIS OF GLENVIEW LLC
Entity type:Organization
Organization Name:SATELLITE DIALYSIS OF GLENVIEW LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:847-832-0001
Mailing Address - Fax:650-625-6007
Practice Address - Street 1:2601 COMPASS RD
Practice Address - Street 2:SUITE 145
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8077
Practice Address - Country:US
Practice Address - Phone:847-832-0001
Practice Address - Fax:847-724-4560
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATELLITE HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-01
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
IL237290564001Medicaid
142746Medicare Oscar/Certification