Provider Demographics
NPI:1336182740
Name:ARA-HAZLETON LLC
Entity Type:Organization
Organization Name:ARA-HAZLETON LLC
Other - Org Name:THE KIDNEY CENTER OF GREATER HAZLETON
Other - Org Type:Doing Business As
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 1:426 AIRPORT RD
Mailing Address - Street 2:2 BELTWAY COMMONS
Mailing Address - City:HAZLE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18202-3361
Mailing Address - Country:US
Mailing Address - Phone:570-450-0870
Mailing Address - Fax:570-450-0874
Practice Address - Street 1:426 AIRPORT RD
Practice Address - Street 2:2 BELTWAY COMMONS
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-3361
Practice Address - Country:US
Practice Address - Phone:570-450-0870
Practice Address - Fax:570-450-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2023-01-10
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
PA0018662430001Medicaid
PA392688Medicare Oscar/Certification