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General NPI Number Information
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NPI Number | 1063432672
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Entity Type | Organization
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Legal Business Name | CORAM ALTERNATE SITE SERVICES INC
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 180 PASSAIC AVE
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City | FAIRFIELD
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State | NJ
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Zip | 07004-3516
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Country | US
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Telephone | 973-756-5963
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 809160
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City | CHICAGO
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State | IL
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Zip | 60680-9160
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Country | US
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Telephone | 303-672-8631
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Fax | 303-298-0047
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRICIA LACAVICH
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Credential |
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Telephone | 314-306-3255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HP0218401
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | HP0218401
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License Number State | NJ
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