Organization
ARA-SOUTH LABURNUM DIALYSIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA BRADY (CHIEF NURSING OFFICER)
(208) 371-7878
Entity
Organization
Contact information
Practice address
4817 S LABURNUM AVE, RICHMOND, VA 23231-2713
(804) 222-7718
(804) 222-7719
Mailing address
4817 S LABURNUM AVE, RICHMOND, VA 23231-2713
(804) 222-7718
(804) 222-7719
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093856643
—
VA
Enumeration date
02/08/2007
Last updated
01/11/2023
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