MEDICARE: CORALVITA RICHARDSON, LLC

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	282E00000X	Long Term Care Hospital

General Provider Information

NPI Number	:	1710867775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORALVITA RICHARDSON, LLC

Provider Business Mailing Address
First Line	:	400 LAS COLINAS BLVD E
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-5579
Country	:	US
Telephone Number	:	972-567-4932
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 LAS COLINAS BLVD E
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-5579
Country	:	US
Telephone Number	:	972-567-4932
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MS. ASHLEY ANASTASIA
Credential	:
Telephone Number	:	813-743-2742

Provider Enumeration Date	:	09/02/2025
Last Update Date	:	09/02/2025

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