Healthcare Provider Details

I. General information

NPI: 1053365544
Provider Name (Legal Business Name): CORAM HEALTHCARE CORPORATION OF SOUTHERN FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/07/2023
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 N UNIVERSITY DR
PLANTATION FL
33324-2002
US

IV. Provider business mailing address

PO BOX 809160
CHICAGO IL
60680-9160
US

V. Phone/Fax

Practice location:
  • Phone: 954-829-4490
  • Fax:
Mailing address:
  • Phone: 480-765-5043
  • Fax: 401-733-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPH23578
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberHHA20290096
License Number StateFL

VIII. Authorized Official

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