Provider Demographics
NPI:1689069676
Name:CORAM HEALTHCARE CORPORATION OF GREATER DC
Entity Type:Organization
Organization Name:CORAM HEALTHCARE CORPORATION OF GREATER DC
Other - Org Name:CORAM CVS/SPECIALTY INFUSION SERVICES
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 1:555 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:
Mailing Address - Fax:
Practice Address - Street 1:9520 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1436
Practice Address - Country:US
Practice Address - Phone:410-720-6501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORAM HEALTHCARE CORPORATION OF GREATER DC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-06
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy