Provider Demographics
NPI:1083046247
Name:WELLBOUND OF MOUNTAIN VIEW LLC
Entity type:Organization
Organization Name:WELLBOUND OF MOUNTAIN VIEW LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:300 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:650-417-6460
Mailing Address - Fax:650-625-6007
Practice Address - Street 1:247 W EL CAMINO REAL
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2605
Practice Address - Country:US
Practice Address - Phone:650-417-6460
Practice Address - Fax:650-404-6007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATELLITE HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-30
Last Update Date:2024-05-15
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
CA1083046247Medicaid
CA1083046247Medicaid