Healthcare Provider Details

I. General information

NPI: 1750310587
Provider Name (Legal Business Name): CORAM ALTERNATE SITE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 CONTEC DR
LANSING MI
48910-7101
US

IV. Provider business mailing address

PO BOX 809160
CHICAGO IL
60680-9160
US

V. Phone/Fax

Practice location:
  • Phone: 517-394-0106
  • Fax: 517-394-0109
Mailing address:
  • Phone: 724-873-7720
  • Fax: 949-639-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRICIA L LACAVICH
Title or Position: PRESIDENT
Credential:
Phone: 318-407-1785