Provider Demographics
NPI:1972611176
Name:ARA-NEWCASTLE DIALYSIS LLC
Entity type:Organization
Organization Name:ARA-NEWCASTLE DIALYSIS LLC
Other - Org Name:<UNAVAIL>
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 1:100 SOUTH JEFFERSON ST
Mailing Address - Street 2:SUITE 187
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3847
Mailing Address - Country:US
Mailing Address - Phone:724-652-2585
Mailing Address - Fax:724-652-2144
Practice Address - Street 1:100 SOUTH JEFFERSON ST
Practice Address - Street 2:SUITE 187
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-3847
Practice Address - Country:US
Practice Address - Phone:724-652-2585
Practice Address - Fax:724-652-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2023-01-11
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
PA1012078320001Medicaid
392715Medicare Oscar/Certification