Healthcare Provider Details

I. General information

NPI: 1366499881
Provider Name (Legal Business Name): CORAM ALTERNATE SITE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2006
Last Update Date: 03/07/2023
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 ROXALANA BUSINESS PARK
DUNBAR WV
25064-2727
US

IV. Provider business mailing address

1675 BROADWAY SUITE 900
DENVER CO
80202-4675
US

V. Phone/Fax

Practice location:
  • Phone: 304-768-1241
  • Fax: 304-768-0925
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 Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License NumberN/A
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberSP0552256
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberSP0552256
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberSP0552256
License Number StateWV
# 8
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberSP0552256
License Number StateWV
# 9
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License NumberSP0552256
License Number StateWV
# 10
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TRICIA LACAVICH
Title or Position: PRESIDENT
Credential:
Phone: 318-407-1785