Provider Demographics
NPI:1568404887
Name:CORAM ALTERNATE SITE SERVICES, INC.
Entity Type:Organization
Organization Name:CORAM ALTERNATE SITE SERVICES, INC.
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: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 1:1675 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 1:8200 E 34TH CIR N
Practice Address - Street 2:SUITE 1001
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1349
Practice Address - Country:US
Practice Address - Phone:316-683-9414
Practice Address - Fax:316-683-3469
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORAM ALTERNATE SITE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-12
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA-087-019251E00000X, 251F00000X
KS261QI0500X
332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No251E00000XAgenciesHome Health
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition