Provider Demographics
NPI:1053365544
Name:CORAM HEALTHCARE CORPORATION OF SOUTHERN FLORIDA
Entity type:Organization
Organization Name:CORAM HEALTHCARE CORPORATION OF SOUTHERN FLORIDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESADENT
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACAVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-306-3255
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:401-733-0211
Practice Address - Street 1:261 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2002
Practice Address - Country:US
Practice Address - Phone:954-829-4490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORAM HEALTHCARE CORPORATION OF SOUTHERN FLORIDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 332B00000X
FLHHA20290096251F00000X, 251F00000X
FLPH235783336H0001X, 3336H0001X, 3336M0002X, 3336S0011X, 332BP3500X, 333600000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No251E00000XAgenciesHome Health
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH23578OtherPHARMACY PERMIT
FLHHA20290096OtherHOME HEALTH AGENCY
FLHHA20290096OtherHOME HEALTH AGENCY
FLHHA20290096OtherHOME HEALTH AGENCY