Healthcare Provider Details

I. General information

NPI: 1225147010
Provider Name (Legal Business Name): ARA-JOHNSTON DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 ATWOOD AVE
JOHNSTON RI
02919-3289
US

IV. Provider business mailing address

1526 ATWOOD AVE
JOHNSTON RI
02919-3289
US

V. Phone/Fax

Practice location:
  • Phone: 401-521-0400
  • Fax: 401-521-0403
Mailing address:
  • Phone: 401-521-0400
  • Fax: 401-521-0403

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

VIII. Authorized Official

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