SATELLITE DIALYSIS OF SOUTH STOCKTON LLC (NPI# 1104190826) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104190826 |
| Entity Type | Organization |
| Organization Name | SATELLITE DIALYSIS OF SOUTH STOCKTON LLC |
| Other Organization Name | SATELLITE HEALTHCARE UNIVERSITY PARK |
| Practice Address |
590 E Harding Wy Stockton CA 95204-6110 |
| Mailing Address |
300 Santana Row Suite 300 San Jose CA 95128-2423 |
| Practice Telephone | 2097745800 |
| Practice Fax Number | 2094622118 |
| Mailing Telephone | 2097745800 |
| Mailing Fax Number | 6506256007 |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2016-12-29 |
| Authorized Official Name | SUSAN L DEL BENE (SECRETARY/CFO) |
| Authorized Official Telephone | 6504043618 |
| Is Organization Subpart | Y |
| Parent Organization Name | SATELLITE HEALTHCARE INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 1104190826 | 05 | |
| CA | STATE OF CALIFORNIA | 550002047 | 01 |
| Other Name | Type Code |
|---|---|
| Satellite Healthcare University Park | Doing Business As Name - Organization |
| Street Address |
590 E HARDING WY |
| City | STOCKTON |
| State | CA |
| Zip Code | 95204-6110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962027524 | Kariem Abdelwahed | Licensed Vocational Nurse | 1630 N. Edison St Stockton Ca, Stockton, CA 95204 | 2020-06-10 |
| 1831730555 | Ronnie C Murray | Counselor | 1947 North California Street, Stockton, CA 95204 | 2019-10-03 |
| 1235614116 | Michelle Ann Horn | Marriage & Family Therapist | 3666 Mission Rd, Stockton, CA 95204 | 2018-09-26 |
| 1356830947 | Stockton Pace | PACE Provider Organization | 582 E. Harding Way, Stockton, CA 95204 | 2018-05-09 |
| 1790228781 | Rebecca Phongsa | Counselor | 1947 North Calfornia Street, Suite B, Stockton, CA 95204 | 2016-11-23 |
| 1700332905 | Serim Kang | Driver | 4222 N Pershing Ave, Suite D2, Stockton, CA 95204 | 2016-08-28 |
| 1033565544 | Philip John Brereton | Orthotist | 466 E Harding Way, Stockton, CA 95204 | 2016-05-13 |
| 1932507522 | David Grayson | Counselor | 1621 Brookside Rd, Stockton, CA 95204 | 2014-12-12 |
| 1174934897 | Gurtej Malhi | Internal Medicine | 1901 N California Street, Stockton, CA 95204 | 2014-05-15 |
| 1396156170 | Rajesh Saini | Nurse Practitioner | 1805 N California St. Suite 102, Stockton, CA 95204 | 2014-05-14 |
| Find all providers in zip 95204 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437569514 | Coral Dialysis LLC | Clinic/Center | 1810 S Fresno Ave, Stockton, CA 95206-1861 | 2014-04-29 |
| 1518166594 | Stockton Kidney Clinic, LLC | Clinic/Center | 1523 E March Ln, Stockton, CA 95210 | 2007-07-11 |
| 1063586394 | Rai Care Centers of Northern California I, LLC | Clinic/Center | 3115 West March Lane, Stockton, CA 95219-2372 | 2006-11-20 |
| 1144260811 | Wellbound of Stockton LLC | Clinic/Center | 3555 Deer Park Dr, Suite 140, Stockton, CA 95219-2306 | 2006-06-08 |
| 1922069319 | Total Renal Care Inc | Clinic/Center | 7500 West Ln, Stockton, CA 95210-3312 | 2006-03-28 |
| 1437124476 | Dva Healthcare Renal Care Inc | Clinic/Center | 5608 N Pershing Ave, Stockton, CA 95207-4906 | 2006-02-22 |
| 1700203502 | Total Renal Care Inc | Clinic/Center | 7707 Austin Rd, Stockton, CA 95215-8312 | 2014-03-19 |
| 1790929826 | Roose Dialysis LLC | Clinic/Center | 1523 E March Ln, Ste 200, Stockton, CA 95210-5607 | 2009-04-20 |
| 1669546990 | Rai Care Centers of Northern California I, LLC | Clinic/Center | 2350 N California St, Stockton, CA 95204-5506 | 2006-11-20 |
| 1134142565 | Satellite Dialysis of Stockton LLC | Clinic/Center | 1801 E March Ln, Stockton, CA 95210-6629 | 2006-07-26 |
| Find all providers in STOCKTON | ||||
Please comment or provide details below to improve the information on SATELLITE DIALYSIS OF SOUTH STOCKTON LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.