Coram Healthcare Corporation of Northern California

Primary specialty

Home Infusion AgencyTaxonomy code 251F00000X

License

020000338 Issued in CA

Legal business name

CORAM HEALTHCARE CORPORATION OF NORTHERN CALIFORNIA

Doing business as

Coram CVS/specialty Infusion Services

Practice address

1401 Willow Pass Rd
Concord, CA 94520-7982

Phone

(323) 371-5046

NPI assigned

May 6, 2006

Organization subpart

Yes

Parent organization

CORAM HEALTHCARE CORP OF NORTHERN CALIFORNIAAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tricia Lacavich

Title

President

Phone

(314) 306-3255

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Coram CVS/specialty Infusion Services Doing business as

Electronic endpoints 1

Part of

Coram Healthcare Corp O

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• CVS Pharmacy Inc

  dba CVS Pharmacy #10489

  • Pharmacy
  • Fort Worth, TX
  • NPI 1265836324

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1629027867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 809160",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606809160",
            "telephone_number": "480-765-5043",
            "fax_number": "401-733-0211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 WILLOW PASS RD",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945207982",
            "telephone_number": "323-371-5046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORAM HEALTHCARE CORPORATION OF NORTHERN CALIFORNIA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CORAM HEALTHCARE CORP OF NORTHERN CALIFORNIA",
        "enumeration_date": "2006-05-06",
        "last_updated": "2023-03-07",
        "certification_date": "2022-12-16",
        "status": "A",
        "authorized_official_last_name": "LACAVICH",
        "authorized_official_first_name": "TRICIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-306-3255"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "020000338",
            "primary": false
        },
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": "CA",
            "license": "020000338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "PHY49294",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME HEALTH AGENCY",
            "identifier": "020000338",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0522385",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA466360",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Coram CVS/specialty Infusion Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coram CVS/specialty Infusion Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patrick Cooper, MSW
• Tia Cooper
• Victoria Cooper
• David Michael Coplans
• Russell L Copping, D.C.
• Bonnie Cordeiro, M.S., S.A.P.
• Nadia Guadalupe Cordero Pantoja
• Cristina Alicia Cordero
• Alvaro J Cordoba
• Arianna Michelle Cordova

• Home Infusion Agency in Concord, CA
• Providers in Concord, CA by specialty
• Home Infusion Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.