Provider Demographics
NPI:1548272701
Name:CORAM HEALTHCARE CORPORATION OF KENTUCKY
Entity type:Organization
Organization Name:CORAM HEALTHCARE CORPORATION OF KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP
Authorized Official - Prefix:
Authorized Official - First Name:VITO
Authorized Official - Middle Name:
Authorized Official - Last Name:PONZIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:303-672-8631
Mailing Address - Street 1:1675 BROADWAY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-4675
Mailing Address - Country:US
Mailing Address - Phone:303-672-8631
Mailing Address - Fax:303-298-0047
Practice Address - Street 1:4305 MULHAUSER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2263
Practice Address - Country:US
Practice Address - Phone:513-874-1161
Practice Address - Fax:513-874-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY720060251E00000X, 251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY720060OtherMOBILE HEALTH PERMIT