=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710867775
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORALVITA RICHARDSON, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2025
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 LAS COLINAS BLVD E
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75039-5579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-567-4932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 LAS COLINAS BLVD E
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75039-5579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-567-4932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MS. ASHLEY ANASTASIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-743-2742
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282E00000X
-----------------------------------------------------
Taxonomy Name | Long Term Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------