1568404887 NPI number — CORAM ALTERNATE SITE SERVICES, INC.

Table of content: (NPI 1568404887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568404887 NPI number — CORAM ALTERNATE SITE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORAM ALTERNATE SITE SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CORAM SPECIALTY INFUSION SERVICES, AN APRIA HEALTHCARE COMPANY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568404887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1675 BROADWAY
Provider Second Line Business Mailing Address:
SUITE 900
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80202-4675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-672-8631
Provider Business Mailing Address Fax Number:
303-298-0047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 E 34TH CIR N
Provider Second Line Business Practice Location Address:
SUITE 1001
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67226-1349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-683-9414
Provider Business Practice Location Address Fax Number:
316-683-3469
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LACAVICH
Authorized Official First Name:
TRICIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
318-407-1785

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  A-087-019 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X , with the licence number: A-087-019 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QI0500X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com