Organization
CORAM ALTERNATE SITE SERVICES, INC.
Active
Parent organization
CORAM ALTERNATE SITE SERVICES, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CORAM ALTERNATE SITE SERVICES, INC.
Authorized official
TRICIA L LACAVICH (PRESIDENT)
(318) 407-1785
Entity
Organization
Contact information
Practice address
1009 LARK ST, SUITE 2, JOHNSON CITY, TN 37604-8217
(423) 434-0110
(423) 434-0095
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
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
0000001704
TN
333600000X
Pharmacy
0000001704
TN
3336C0003X
Community/Retail Pharmacy
0000001704
TN
3336H0001X
Home Infusion Therapy Pharmacy
Primary
0000001704
TN
3336M0002X
Mail Order Pharmacy
0000001704
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000001704
RX LICENSE
TN
05
—
008506671
—
VA
05
—
009111158
—
VA
05
—
0445486
—
NC
05
—
145206
—
TN
01
—
4426892
NCPDP
—
05
—
7701520
—
NC
Enumeration date
08/21/2006
Last updated
03/07/2023
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