Provider Demographics
NPI:1003848375
Name:CENTERWELL CERTIFIED HEALTHCARE CORP.
Entity Type:Organization
Organization Name:CENTERWELL CERTIFIED HEALTHCARE CORP.
Other - Org Name:CENTERWELL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-723-8999
Mailing Address - Street 1:6330 SPRINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 E SUPERIOR ST STE 508
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-3014
Practice Address - Country:US
Practice Address - Phone:218-723-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN169027Medicaid
247241OtherMN-COMMERCIAL NUMBER
MN4117KIMedicaid
5900031OtherMN-COMMERCIAL NUMBER
GA0785OtherMN-COMMERCIAL NUMBER
169027OtherMN-COMMERCIAL NUMBER
013100POtherMN-COMMERCIAL NUMBER
MN023355200Medicaid
4117KIOtherMN-COMMERCIAL NUMBER
991234OtherMN-COMMERCIAL NUMBER
ANC015OtherMN-COMMERCIAL NUMBER
MN5900031Medicaid
109673OtherMN-COMMERCIAL NUMBER
MN4117KIMedicaid
5900031OtherMN-COMMERCIAL NUMBER