=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689181661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIOSCRIP NURSING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2017
-----------------------------------------------------
Last Update Date | 06/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 CLEARBROOK RD STE 180
-----------------------------------------------------
City | ELMSFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-425-1706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 BROADWAY STE 700
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80202-4967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-697-5171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR VP, GC AND SECRETARY
-----------------------------------------------------
Name | KATHRYN STALMACK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 720-697-5171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------