CORAM HEALTHCARE CORPORATION OF SOUTHERN CALIFORNIA (NPI# 1811946759) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811946759 |
| Entity Type | Organization |
| Organization Name | CORAM HEALTHCARE CORPORATION OF SOUTHERN CALIFORNIA |
| Other Organization Name | CORAM CVS/SPECIALTY INFUSION SERVICES |
| Practice Address |
2710 Media Center Dr Bldg 6 Ste 150 Los Angeles CA 90065-1733 |
| Mailing Address |
555 17th St Suite 1500 Denver CO 80202-3950 |
| Practice Telephone | 8185435169 |
| Practice Fax Number | 8189560411 |
| Mailing Telephone | 3036728631 |
| Mailing Fax Number | 3032980047 |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2016-03-24 |
| Authorized Official Name | JODY L KEPLER (PRESIDENT) |
| Authorized Official Telephone | 3032924973 |
| Is Organization Subpart | Y |
| Parent Organization Name | CORAM HEALTHCARE CORPORATION OF SOUTHERN CALIFORNIA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | PHY49298 | CA | Suppliers |
| N | 251E00000X | Home Health | 9800724 | CA | Agencies |
| N | 251F00000X | Home Infusion | 9800724 | CA | Agencies |
| N | 261QI0500X |
Clinic/Center Specialization: Infusion Therapy |
CA | Ambulatory Health Care Facilities | |
| N | 332BP3500X |
Durable Medical Equipment & Medical Supplies Specialization: Parenteral & Enteral Nutrition |
PHY 41494 | CA | Suppliers |
| N | 333600000X | Pharmacy | PHY 41494 | CA | Suppliers |
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
PHY 41494 | CA | Suppliers |
| N | 3336M0002X |
Pharmacy Specialization: Mail Order Pharmacy |
-PHY 41494 | CA | Suppliers |
| Y | 3336H0001X |
Pharmacy Specialization: Home Infusion Therapy Pharmacy |
PHY 41494 | CA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | BC4821612 | 01 | |
| CA | PHA414940 | 05 | |
| NCPDP | 0522525 | 01 | |
| CA | HOME HEALTH AGENCY | 9800724 | 01 |
| CA | PHARMACY LICENSE | PHY49298 | 01 |
| Other Name | Type Code |
|---|---|
| Coram CVS/specialty Infusion Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730295650 | Coram Healthcare Corporation of Southern California | Home Health | 3002 Dow Ave, Ste 104, Tustin, CA 92780-7233 | 2006-08-22 |
| 1013966993 | Coram Healthcare Corporation of Southern California | Home Infusion | 5571 Ekwill St, Ste A-b, Goleta, CA 93111-2346 | 2006-05-09 |
| 1740239623 | Coram Healthcare Corporation of Southern California | Home Health | 4355 E Lowell St, Ste C, Ontario, CA 91761-2225 | 2006-05-09 |
| 1881078475 | Coram Healthcare Corporation of Southern California | Clinic/Center | 2791 Agoura Rd, Thousand Oaks, CA 91361-3101 | 2015-07-14 |
| 1861530099 | Coram Healthcare Corporation of Southern California | Home Health | 1675 Broadway, Ste 900, Denver, CO 80202-4675 | 2007-02-01 |
| Street Address |
2710 MEDIA CENTER DR BLDG 6 STE 150 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90065-1733 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134613177 | Carmela Hermann Dietrich | Massage Therapist | 546 Frontenac Avenue, Los Angeles, CA 90065 | 2018-06-21 |
| 1245421981 | Kerry Glen Thorne | Marriage & Family Therapist | 3374 Scarboro St, Los Angeles, CA 90065 | 2007-08-07 |
| 1275654311 | Cal Care Ambulance Service | Ambulance | 2829 N. San Fernando Rd #203, Los Angeles, CA 90065 | 2007-04-03 |
| 1053430116 | Feliza Perez | Rehabilitation Practitioner | 2677 1/2 202 Ave, Huntington Park, CA 90065 | 2007-03-28 |
| 1154475382 | Grace O Serrano | Dentist | 4146 Verdugo Rd, Los Angeles, CA 90065 | 2007-01-23 |
| 1265532519 | Dae H Song | Dentist | 3129 San Fernando Rd, Los Angeles, CA 90065 | 2006-09-25 |
| 1730289737 | Calox Inc | Durable Medical Equipment & Medical Supplies | 3034 Fierro Street, Los Angeles, CA 90065 | 2006-09-22 |
| 1093224131 | Andre Marderosian | Dentist | 3129 N San Fernando Rd, Los Angeles, CA 90065 | 2017-09-20 |
| 1710345491 | Golden Van Rides Inc. | Non-emergency Medical Transport (VAN) | 3920 Eagle Rock Blvd, Suite C, Los Angeles, CA 90065 | 2016-02-09 |
| 1841467396 | Highland Medical Equipment Inc | Durable Medical Equipment & Medical Supplies | 2648 N Figueroa St, Los Angeles, CA 90065-1026 | 2008-05-14 |
| Find all providers in zip 90065 | ||||
| Taxonomy Code | 3336H0001X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Home Infusion Therapy Pharmacy |
| Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. Extensive professional pharmacy services, care coordination, infusion nursing services, supplies and equipment are provided to optimize efficacy and compliance. |
| Notes: Source: National Home Infusion Association [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154875466 | Medquick Prescription Shoppe Inc | Pharmacy | 923 Cole Ave, Los Angeles, CA 90038-2610 | 2016-08-04 |
| 1356397756 | Accentcare Home Health of California, Inc | Pharmacy | 5340 Alla Rd, Suite 105, Los Angeles, CA 90066-7004 | 2006-05-26 |
| 1174582613 | Iv Solutions Inc. | Pharmacy | 3384 Motor Ave, Los Angeles, CA 90034-3712 | 2006-03-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447897921 | Pharmacy Home Infusion Network | Pharmacy | 900 W Glenoaks Blvd Ste G, Glendale, CA 91202-2664 | 2019-12-04 |
| 1073085007 | Kaiser Foundation Health Plan Inc | Pharmacy | 615 W Avenue L Trailer, Lancaster, CA 93534-7211 | 2019-01-02 |
| 1386155752 | Toci Health Inc | Pharmacy | 8851 Watson St Apt B, Cypress, CA 90630-2269 | 2017-10-12 |
| 1841665973 | Biomed California, Inc | Pharmacy | 721 S Glasgow Ave., Suite C, Inglewood, CA 90301-3016 | 2015-12-01 |
| 1790158756 | Soleo Health Inc. | Pharmacy | 1324 W. Winton Ave, Hayward, CA 94545-1408 | 2015-11-12 |
| 1982013462 | Medrx Infusion Clinical Pharmacy, LLC | Pharmacy | 415 N Oak St, Inglewood, CA 90302-3314 | 2014-08-08 |
| 1669884722 | Dm Clinical Collaborations | Pharmacy | 6108 San Fernando Rd, Glendale, CA 91201-2240 | 2014-05-23 |
| 1609209352 | Santa Barbara Specialty Pharmacy LLC | Pharmacy | 4690 Carpinteria Ave Ste B, Carpinteria, CA 93013-1875 | 2013-08-16 |
| 1265773501 | Saint Paul Enterprises, Inc. | Pharmacy | 1010 E Arrow Hwy, Covina, CA 91724-1020 | 2013-03-12 |
| 1972841872 | Biologic Infusion Inc | Pharmacy | 8851 Watson St Ste A, Cypress, CA 90630-2268 | 2013-01-28 |
| Find all providers with the same taxonomy | ||||
| City | LOS ANGELES |
| Zip Code | 90065 |
Please comment or provide details below to improve the information on CORAM HEALTHCARE CORPORATION OF SOUTHERN CALIFORNIA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.