Provider Demographics
NPI:1083641997
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:319-393-4742
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 1:1305 BOYSON LOOP STE B
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1382
Practice Address - Country:US
Practice Address - Phone:319-393-4742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
013100POtherIA-COMMERCIAL NUMBER
GA0778OtherIA-COMMERCIAL NUMBER
0671248OtherIA-COMMERCIAL NUMBER
IA0671248Medicaid
565800OtherIA-COMMERCIAL NUMBER
67124OtherIA-COMMERCIAL NUMBER
ANC015OtherIA-COMMERCIAL NUMBER
113414024DOtherIA-COMMERCIAL NUMBER
167124OtherIA-COMMERCIAL NUMBER
047038OtherIA-COMMERCIAL NUMBER
IA0671321Medicaid
0671248OtherIA-COMMERCIAL NUMBER
565800OtherIA-COMMERCIAL NUMBER
IA0671321Medicaid