Provider Demographics
NPI:1508136060
Name:CORAM HEALTHCARE CORPORATION OF GREATER NEW YORK
Entity Type:Organization
Organization Name:CORAM HEALTHCARE CORPORATION OF GREATER NEW YORK
Other - Org Name:CORAM SPECIALTY INFUSION SERVICES, AN APRIA HEALTHCARE COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-672-8631
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 1:300 ENTERPRISE DR STE 506
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-7004
Practice Address - Country:US
Practice Address - Phone:845-336-5323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORAM HEALTHCARE CORPORATION OF GREATER NEW YORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-30
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9836L002251E00000X, 251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1683L006OtherHOME HEALTH AGENCY