Organization
WELLBOUND OF MODESTO LLC
Active
Parent organization
WELLBOUND LLC
Other names
WellBound of Modesto
Organization subpart
Yes
Provider details
NPI number
Legal business name
WELLBOUND LLC
Authorized official
THOMAS L WEINBERG (CHAIRMAN)
(214) 736-2700
Entity
Organization
Contact information
Practice address
1315 10TH ST, SUITE 100, MODESTO, CA 95354-0714
(209) 238-4080
(209) 238-4084
Mailing address
300 SANTANA ROW, 300, SAN JOSE, CA 95128-2423
(209) 238-4080
(650) 625-6007
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CDC52524F
—
CA
Enumeration date
02/03/2006
Last updated
05/15/2024
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