Healthcare Provider Details

I. General information

NPI: 1134228745
Provider Name (Legal Business Name): CORAM HEALTHCARE CORPORATION OF GREATER DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/07/2023
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 FAIRVIEW PARK DR
FALLS CHURCH VA
22042-4530
US

IV. Provider business mailing address

PO BOX 809160
CHICAGO IL
60680-9160
US

V. Phone/Fax

Practice location:
  • Phone: 443-669-8675
  • Fax: 703-631-6738
Mailing address:
  • Phone: 480-765-5043
  • Fax: 401-733-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-176
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberHCO-176
License Number StateVA

VIII. Authorized Official

Name: TRICIA LACAVICH
Title or Position: PRESIDENT
Credential:
Phone: 314-306-3255