Provider Demographics
NPI:1417134206
Name:NRA-LAGRANGE, GEORGIA, LLC
Entity Type:Organization
Organization Name:NRA-LAGRANGE, GEORGIA, LLC
Other - Org Name:LAGRANGE DIALYSIS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:140 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-6704
Mailing Address - Country:US
Mailing Address - Phone:706-884-6825
Mailing Address - Fax:706-884-6851
Practice Address - Street 1:140 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-6704
Practice Address - Country:US
Practice Address - Phone:706-884-6825
Practice Address - Fax:706-884-6851
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-24
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment