Provider Demographics
NPI:1770797821
Name:ARA-RHODE ISLAND DIALYSIS II LLC
Entity type:Organization
Organization Name:ARA-RHODE ISLAND DIALYSIS II LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VP OF CLINICAL & REGULATORY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:COUSINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-922-3080
Mailing Address - Street 1:318 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3525
Mailing Address - Country:US
Mailing Address - Phone:401-435-5200
Mailing Address - Fax:401-435-5995
Practice Address - Street 1:318 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-3525
Practice Address - Country:US
Practice Address - Phone:401-435-5200
Practice Address - Fax:401-435-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAR38642Medicaid
RI709005634Medicare Oscar/Certification