Provider Demographics
NPI:1114955713
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:AUTHORIZED SIGNATORY
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:386-274-1088
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 1:1737 N CLYDE MORRIS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5534
Practice Address - Country:US
Practice Address - Phone:386-274-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
00011327202OtherG2
107937315OtherG2
095190OtherG2
11-3414024OtherG2
146544OtherG2
013100POtherG2
2196642OtherG2
1016435OtherG2
2117426OtherG2
112645333OtherG2
113414024GOtherG2
FL027154301Medicaid
080053OtherG2
107338OtherG2
00011327202OtherG2
113414024GOtherG2
2196642OtherG2
=========053Other1H
107338AMedicare Oscar/Certification
107338AMedicare Oscar/Certification