Provider Demographics
NPI:1386755668
Name:ARA-CHILLICOTHE DIALYSIS LLC
Entity type:Organization
Organization Name:ARA-CHILLICOTHE DIALYSIS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF CLINICAL & REGULATORY
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-522-3905
Mailing Address - Street 1:465 SHAWNEE LN
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-4145
Mailing Address - Country:US
Mailing Address - Phone:740-774-4777
Mailing Address - Fax:740-774-4774
Practice Address - Street 1:465 SHAWNEE LN
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-4145
Practice Address - Country:US
Practice Address - Phone:740-774-4777
Practice Address - Fax:740-774-4774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-08-19
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
OH2576949Medicaid
OH2576949Medicaid