Healthcare Provider Details

I. General information

NPI: 1609899590
Provider Name (Legal Business Name): CORAM ALTERNATE SITE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/07/2023
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WYNKOOP ST
DENVER CO
80202-1150
US

IV. Provider business mailing address

PO BOX 809160
CHICAGO IL
60680-9160
US

V. Phone/Fax

Practice location:
  • Phone: 303-799-0093
  • Fax: 303-790-0633
Mailing address:
  • Phone: 480-765-5043
  • Fax: 401-733-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number370000024
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number370000024
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number370000024
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: TRICIA LACAVICH
Title or Position: PRESIDENT
Credential:
Phone: 314-306-3255