Provider Demographics
NPI:1902208879
Name:CORAM HEALTHCARE CORPORATION OF NORTH TEXAS
Entity Type:Organization
Organization Name:CORAM HEALTHCARE CORPORATION OF NORTH TEXAS
Other - Org Name:CORAM CVS/SPECIALTY INFUSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP, GC, SEC AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DELL
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:303-672-8631
Mailing Address - Fax:
Practice Address - Street 1:6000 BRYANT IRVIN RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4116
Practice Address - Country:US
Practice Address - Phone:214-902-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORAM HEALTHCARE CORPORATION OF NORTH TEXAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy