Provider Demographics
NPI:1023045390
Name:CENTERWELL HEALTH SERVICES (CERTIFIED), INC.
Entity Type:Organization
Organization Name:CENTERWELL HEALTH SERVICES (CERTIFIED), INC.
Other - Org Name:CENTERWELL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SIGNATORY AUTHORITY
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:407-894-5703
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 1:4776 NEW BROAD ST
Practice Address - Street 2:SUITE 110
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6423
Practice Address - Country:US
Practice Address - Phone:407-894-5703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
107234OtherG2
2117427OtherG2
113414024OtherG2
113414024GOtherG2
107937319OtherG2
235397OtherG2
115712OtherG2
249710OtherG2
080053OtherG2
112645333OtherG2
146544OtherG2
013100POtherG2
1016457OtherG2
2196640OtherG2
2196640OtherG2
107937319OtherG2
=========OtherG2
=========COtherG2
107234AMedicare Oscar/Certification
FL028118200Medicaid