Organization
CORAM ALTERNATE SITE SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRICIA LACAVICH (PRESIDENT)
(318) 407-1785
Entity
Organization
Contact information
Practice address
206 ROXALANA BUSINESS PARK, DUNBAR, WV 25064-2727
(304) 768-1241
(304) 768-0925
Mailing address
1675 BROADWAY, SUITE 900, DENVER, CO 80202-4675
(303) 672-8631
(303) 298-0047
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251F00000X
Home Infusion Agency
—
—
261QI0500X
Infusion Therapy Clinic/Center
N/A
WV
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
SP0552256
WV
333600000X
Pharmacy
SP0552256
WV
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
SP0552256
WV
3336H0001X
Home Infusion Therapy Pharmacy
SP0552256
WV
3336H0001X
Home Infusion Therapy Pharmacy
Primary
—
—
3336M0002X
Mail Order Pharmacy
SP0552256
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5010486
NCPDP
—
05
—
5403328700
—
KY
05
—
8508001
—
WV
05
—
90009721
—
KY
01
—
SP0552256
RX LICENSE
WV
Enumeration date
05/29/2006
Last updated
03/07/2023
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