Provider Demographics
NPI:1306085964
Name:CORAM ALTERNATE SITE SERVICES, INC.
Entity type:Organization
Organization Name:CORAM ALTERNATE SITE SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LACAVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-407-1785
Mailing Address - Street 1:555 17TH ST
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-3950
Mailing Address - Country:US
Mailing Address - Phone:303-672-8631
Mailing Address - Fax:303-298-0047
Practice Address - Street 1:9310 SOUTHPARK CENTER LOOP
Practice Address - Street 2:SUITE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8634
Practice Address - Country:US
Practice Address - Phone:407-571-6834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORAM ALTERNATE SITE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-05
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299991256OtherHOME HEALTH AGENCY