Provider Demographics
NPI:1114959186
Name:ARA-SOUTH BOCA RATON DIALYSIS LLC
Entity Type:Organization
Organization Name:ARA-SOUTH BOCA RATON DIALYSIS LLC
Other - Org Name:CONVALESCENT RENAL CARE OF SOUTH FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-922-3080
Mailing Address - Street 1:66 CHERRY HILL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1054
Mailing Address - Country:US
Mailing Address - Phone:978-922-3080
Mailing Address - Fax:978-922-3085
Practice Address - Street 1:7300 DEL PRADO CIR S
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3386
Practice Address - Country:US
Practice Address - Phone:561-416-2039
Practice Address - Fax:561-416-5756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102781Medicare ID - Type Unspecified