Healthcare Provider Details

I. General information

NPI: 1285745570
Provider Name (Legal Business Name): ARA-TIVERTON DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HURST LN
TIVERTON RI
02878-2312
US

IV. Provider business mailing address

22 HURST LN
TIVERTON RI
02878-2312
US

V. Phone/Fax

Practice location:
  • Phone: 401-624-4403
  • Fax: 401-624-4623
Mailing address:
  • Phone: 401-624-4403
  • Fax: 401-624-4623

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