Healthcare Provider Details

I. General information

NPI: 1770797821
Provider Name (Legal Business Name): ARA-RHODE ISLAND DIALYSIS II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 WATERMAN AVE
EAST PROVIDENCE RI
02914-3525
US

IV. Provider business mailing address

318 WATERMAN AVE
EAST PROVIDENCE RI
02914-3525
US

V. Phone/Fax

Practice location:
  • Phone: 401-435-5200
  • Fax: 401-435-5995
Mailing address:
  • Phone: 401-435-5200
  • Fax: 401-435-5995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARI COUSINS
Title or Position: SR. VP OF CLINICAL & REGULATORY
Credential:
Phone: 978-922-3080