Provider Demographics
NPI:1124276753
Name:ARA DIALYSIS UNIT AT OHIO VALLEY HOSPITAL LLC
Entity type:Organization
Organization Name:ARA DIALYSIS UNIT AT OHIO VALLEY HOSPITAL 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 1:27 HECKEL RD STE 113
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1672
Mailing Address - Country:US
Mailing Address - Phone:412-331-2423
Mailing Address - Fax:412-331-2481
Practice Address - Street 1:27 HECKEL RD STE 113
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1672
Practice Address - Country:US
Practice Address - Phone:412-331-2423
Practice Address - Fax:412-331-2481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
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
PA1023241450001Medicaid
392759Medicare Oscar/Certification