Provider Demographics
NPI:1740230135
Name:CORAM ALTERNATE SITE SERVICES INC
Entity Type:Organization
Organization Name:CORAM ALTERNATE SITE SERVICES INC
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:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEINERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-765-1500
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:480-765-5043
Mailing Address - Fax:303-298-0047
Practice Address - Street 1:2 BARNES INDUSTRIAL PARK ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2426
Practice Address - Country:US
Practice Address - Phone:203-284-8558
Practice Address - Fax:203-284-8580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORAM ALTERNATE SITE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-10
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251F00000X, 332B00000X
MA261QI0500X
CTPCY.0001335332BP3500X, 333600000X, 3336C0003X, 3336H0001X
MADS 2584-13336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004138972Medicaid
0716425OtherNCPDP
CTPCY.0001335OtherRX LICENSE
CT004143145Medicaid
BC4419900OtherDEA
BC4419900OtherDEA
BC4419900OtherDEA