MEDICARE: CORAM HEALTHCARE CORPORATION OF SOUTHERN FLORIDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	3336H0001X	Home Infusion Therapy Pharmacy	PH23578	FL
3	251F00000X	Home Infusion Agency	HHA20290096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PH23578	OTHER	FL	PHARMACY PERMIT
2	HHA20290096	OTHER	FL	HOME HEALTH AGENCY

General Provider Information

NPI Number	:	1053365544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAM HEALTHCARE CORPORATION OF SOUTHERN FLORIDA

Provider Business Mailing Address
First Line	:	PO BOX 809160
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60680-9160
Country	:	US
Telephone Number	:	480-765-5043
Fax Number	:	401-733-0211

Provider Business Practice Location Address
First Line	:	261 N UNIVERSITY DR
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-2002
Country	:	US
Telephone Number	:	954-829-4490
Fax Number	:

Authorized Official
Title or Position	:	PRESADENT
Name	:	TRICIA LACAVICH
Credential	:
Telephone Number	:	314-306-3255

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	03/07/2023

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