Organization
WELLBOUND OF LAFAYETTE LLC
Active
Parent organization
WELLBOUND LLC
Other names
WellBound of Lafayette
Organization subpart
Yes
Provider details
NPI number
Legal business name
WELLBOUND LLC
Authorized official
SUSAN L DEL BENE (SECRETARY/CFO)
(650) 404-3618
Entity
Organization
Contact information
Practice address
2 EXECUTIVE DR, SUITE B, LAFAYETTE, IN 47905-4878
(765) 446-1627
(765) 449-9475
Mailing address
300 SANTANA ROW, SUITE 300, SAN JOSE, CA 95128-2423
(765) 446-1627
(650) 625-6007
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200843920A
—
IN
Enumeration date
07/16/2006
Last updated
12/29/2016
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