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General NPI Number Information
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NPI Number | 1750672903
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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 | 04/22/2011
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 720 OLIVE WAY STE 815
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City | SEATTLE
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State | WA
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Zip | 98101-1836
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Country | US
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Telephone | 425-883-3525
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Fax | 425-881-8779
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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 L LACAVICH
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Credential |
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Telephone | 318-407-1785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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