Provider Demographics
NPI:1235232133
Name:ARA-FALL RIVER DIALYSIS LLC
Entity Type:Organization
Organization Name:ARA-FALL RIVER DIALYSIS LLC
Other - Org Name:DIALYSIS CENTER OF FALL RIVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-922-3080
Mailing Address - Street 1:221 WEAVER ST
Mailing Address - Street 2:UNITS 5 & 6
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-1345
Mailing Address - Country:US
Mailing Address - Phone:508-676-0112
Mailing Address - Fax:508-676-0113
Practice Address - Street 1:221 WEAVER ST
Practice Address - Street 2:UNITS 5 & 6
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1345
Practice Address - Country:US
Practice Address - Phone:508-676-0112
Practice Address - Fax:508-676-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2017-03-16
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
MA1301195Medicaid
RIFR58353Medicaid
RIFR58353Medicaid