Provider Demographics
NPI:1063424216
Name:CORAM HEALTHCARE CORPORATION OF GREATER NEW YORK
Entity type:Organization
Organization Name:CORAM HEALTHCARE CORPORATION OF GREATER NEW YORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACAVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-306-3255
Mailing Address - Street 1:PO BOX 809160
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-9160
Mailing Address - Country:US
Mailing Address - Phone:303-672-8631
Mailing Address - Fax:303-298-0047
Practice Address - Street 1:28-07 JACKSON AVENUE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11101-1110
Practice Address - Country:US
Practice Address - Phone:516-491-7930
Practice Address - Fax:718-730-9398
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORAM HEALTHCARE CORPORATION OF GREATER NEW YORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-13
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9073L002251E00000X, 251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9073L002OtherHOME HEALTH AGENCY