Healthcare Provider Details

I. General information

NPI: 1710867775
Provider Name (Legal Business Name): CORALVITA RICHARDSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W CAMPBELL RD STE 300
RICHARDSON TX
75080
US

IV. Provider business mailing address

400 E LAS COLINAS BLVD STE 300
IRVING TX
75039-5579
US

V. Phone/Fax

Practice location:
  • Phone: 469-329-7263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANIS SABETI
Title or Position: CEO
Credential:
Phone: 844-426-7258