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General NPI Number Information
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NPI Number | 1790734036
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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 | 05/05/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 12310 WORLD TRADE DR SUITE 100
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City | SAN DIEGO
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State | CA
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Zip | 92128-3793
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Country | US
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Telephone | 858-576-6969
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Fax | 858-974-6606
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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 | 480-765-5043
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Fax | 401-733-0211
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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 | 0800429
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License Number State | CA
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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 | 0800429
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License Number State | CA
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Taxonomy #3
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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 | CA
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PHY50273
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | PHY50273
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY50273
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY50273
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License Number State | CA
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Taxonomy #8
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PHY50273
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License Number State | CA
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Taxonomy #9
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | PHY50273
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License Number State | CA
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Taxonomy #10
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PHY50273
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License Number State | CA
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Taxonomy #11
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | PHY50273
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License Number State | CA
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