Provider Demographics
NPI:1093747347
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:W
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-223-8310
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 1:10825 FINANCIAL CENTRE PKWY STE 210
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3545
Practice Address - Country:US
Practice Address - Phone:501-223-8310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
112135OtherAR-COMMERCIAL NUMBER
AR129059514Medicaid
1500992OtherAR-COMMERCIAL NUMBER
AR129058732Medicaid
AR145488738Medicaid
235397OtherAR-COMMERCIAL NUMBER
17029OtherAR-COMMERCIAL NUMBER
AR122835716Medicaid
0564382OtherAR-COMMERCIAL NUMBER
11341402450OtherAR-COMMERCIAL NUMBER
17900OtherAR-COMMERCIAL NUMBER
013100POtherAR-COMMERCIAL NUMBER
047029OtherAR-COMMERCIAL NUMBER
AR121950742Medicaid
AR131156742Medicaid
AR145687732Medicaid
115712OtherAR-COMMERCIAL NUMBER
0564382OtherAR-COMMERCIAL NUMBER
AR145488738Medicaid
AR129058732Medicaid