Provider Demographics
NPI:1114958725
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 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:360-373-6966
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 1:10049 KITSAP MALL BLVD NW STE 201
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8901
Practice Address - Country:US
Practice Address - Phone:360-373-6966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
013100POtherWA-COMMERCIAL NUMBER
113414024OtherWA-COMMERCIAL NUMBER
321563003OtherWA-COMMERCIAL NUMBER
565800OtherWA-COMMERCIAL NUMBER
1018057OtherWA-COMMERCIAL NUMBER
11-3414024OtherWA-COMMERCIAL NUMBER
300066152OtherWA-COMMERCIAL NUMBER
651-YIOtherWA-COMMERCIAL NUMBER
135181OtherWA-COMMERCIAL NUMBER
235394OtherWA-COMMERCIAL NUMBER
321563001OtherWA-COMMERCIAL NUMBER
WA9041609Medicaid
2223178OtherWA-COMMERCIAL NUMBER
7271048OtherWA-COMMERCIAL NUMBER
507106OtherWA-COMMERCIAL NUMBER
WA9041591Medicaid
1173OtherWA-BLUE CROSS
WA9041609Medicaid
565800OtherWA-COMMERCIAL NUMBER
565800OtherWA-COMMERCIAL NUMBER