Provider Demographics
NPI:1063681807
Name:CORAM HEALTHCARE CORPORATION OF GREATER D.C.
Entity Type:Organization
Organization Name:CORAM HEALTHCARE CORPORATION OF GREATER D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VITO
Authorized Official - Middle Name:
Authorized Official - Last Name:PONZIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:303-672-8631
Mailing Address - Street 1:1675 BROADWAY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-4675
Mailing Address - Country:US
Mailing Address - Phone:303-672-8631
Mailing Address - Fax:303-298-0047
Practice Address - Street 1:4115 PLEASANT VALLEY RD STE 600
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1223
Practice Address - Country:US
Practice Address - Phone:703-631-1611
Practice Address - Fax:703-631-6738
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORAM HEALTHCARE CORPORATION OF GREATER D.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPO2111OtherOUT OF STATE PHARMACY
VA0201002670OtherSTATE PHARMACY
4829846OtherNCPDP
MD465933OtherCONTROLLED SUBSTANCE
VAHCO-08176OtherHOME CARE ORGANIZATION
WVMO0559275OtherOUT OF STATE PHARMACY
WVMO0559275OtherOUT OF STATE PHARMACY
VAHCO-08176OtherHOME CARE ORGANIZATION