1063681807 NPI number — CORAM HEALTHCARE CORPORATION OF GREATER D.C.

Table of content: (NPI 1063681807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063681807 NPI number — CORAM HEALTHCARE CORPORATION OF GREATER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORAM HEALTHCARE CORPORATION OF GREATER D.C.
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:
Provider Other Organization Name Type Code:
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:
1063681807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
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:
4115 PLEASANT VALLEY RD STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANTILLY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20151-1223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-631-1611
Provider Business Practice Location Address Fax Number:
703-631-6738
Provider Enumeration Date:
02/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PONZIO
Authorized Official First Name:
VITO
Authorized Official Middle Name:
Authorized Official Title or Position:
SR VP AND DIRECTOR
Authorized Official Telephone Number:
303-672-8631

Provider Taxonomy Codes

  • Taxonomy code: 261QI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PO2111 . This is a "OUT OF STATE PHARMACY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0201002670 . This is a "STATE PHARMACY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4829846 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 465933 . This is a "CONTROLLED SUBSTANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: HCO-08176 . This is a "HOME CARE ORGANIZATION" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: MO0559275 . This is a "OUT OF STATE PHARMACY" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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