Healthcare Provider Details

I. General information

NPI: 1063681807
Provider Name (Legal Business Name): CORAM HEALTHCARE CORPORATION OF GREATER D.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 PLEASANT VALLEY RD STE 600
CHANTILLY VA
20151-1223
US

IV. Provider business mailing address

1675 BROADWAY SUITE 900
DENVER CO
80202-4675
US

V. Phone/Fax

Practice location:
  • Phone: 703-631-1611
  • Fax: 703-631-6738
Mailing address:
  • Phone: 303-672-8631
  • Fax: 303-298-0047

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