Provider Demographics
NPI:1710867775
Name:CORALVITA RICHARDSON, LLC
Entity type:Organization
Organization Name:CORALVITA RICHARDSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANASTASIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-743-2742
Mailing Address - Street 1:400 LAS COLINAS BLVD E
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-5579
Mailing Address - Country:US
Mailing Address - Phone:972-567-4932
Mailing Address - Fax:
Practice Address - Street 1:400 LAS COLINAS BLVD E
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-5579
Practice Address - Country:US
Practice Address - Phone:972-567-4932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital