Healthcare Provider Details

I. General information

NPI: 1336182740
Provider Name (Legal Business Name): ARA-HAZLETON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 AIRPORT RD 2 BELTWAY COMMONS
HAZLE TOWNSHIP PA
18202-3361
US

IV. Provider business mailing address

426 AIRPORT RD 2 BELTWAY COMMONS
HAZLE TOWNSHIP PA
18202-3361
US

V. Phone/Fax

Practice location:
  • Phone: 570-450-0870
  • Fax: 570-450-0874
Mailing address:
  • Phone: 570-450-0870
  • Fax: 570-450-0874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0018662430001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: SARA ANNE BRADY
Title or Position: CHIEF NURSING OFFICER
Credential:
Phone: 208-371-7878