Healthcare Provider Details

I. General information

NPI: 1548272701
Provider Name (Legal Business Name): CORAM HEALTHCARE CORPORATION OF KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 MULHAUSER RD SUITE 1
FAIRFIELD OH
45014-2263
US

IV. Provider business mailing address

1675 BROADWAY SUITE 900
DENVER CO
80202-4675
US

V. Phone/Fax

Practice location:
  • Phone: 513-874-1161
  • Fax: 513-874-8774
Mailing address:
  • Phone: 303-672-8631
  • Fax: 303-298-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number720060
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number720060
License Number StateKY

VIII. Authorized Official

Name: VITO PONZIO JR.
Title or Position: SR VP
Credential:
Phone: 303-672-8631