Provider Demographics
NPI:1134437213
Name:ARA NAPLES SOUTH DIALYSIS CENTER LLC
Entity type:Organization
Organization Name:ARA NAPLES SOUTH DIALYSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-7878
Mailing Address - Street 1:4270 TAMIAMI TRL E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-6718
Mailing Address - Country:US
Mailing Address - Phone:239-774-7523
Mailing Address - Fax:239-774-1681
Practice Address - Street 1:4270 TAMIAMI TRL E
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-6718
Practice Address - Country:US
Practice Address - Phone:239-774-7523
Practice Address - Fax:239-774-1681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2023-01-13
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
FL003455900Medicaid
FL003455900Medicaid