Healthcare Provider Details

I. General information

NPI: 1427394915
Provider Name (Legal Business Name): CORAM HEALTHCARE CORPORATION OF GREATER NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 CLINTON SQ
ROCHESTER NY
14604-1700
US

IV. Provider business mailing address

555 17TH ST STE 1500
DENVER CO
80202-3900
US

V. Phone/Fax

Practice location:
  • Phone: 716-691-3000
  • Fax:
Mailing address:
  • Phone: 303-672-8812
  • Fax: 303-298-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: JODY L KEPLER
Title or Position: PRESIDENT
Credential:
Phone: 303-672-8812