| Organization Name: | CORAM HEALTHCARE CORPORATION OF SOUTHERN CALIFORNIA |
| NPI Number: | 1013966993 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JODY L KEPLER (PRESIDENT) |
| Mailing Address: | 5571 Ekwill St Ste A-b Goleta |
| State: | CA US |
| Postal Code: | 931112346 |
| Phone Number: | 8056921200 |
| Fax Number: | 8056921201 |
| NPI Enumeration Date: | 05/09/2006 |
| NPI Last Update Date: | 03/24/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | PHY49296 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |