Provider Demographics
NPI:1114959483
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:810-732-9030
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 1:5406 GATEWAY CTR STE B
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3933
Practice Address - Country:US
Practice Address - Phone:810-732-9030
Practice Address - Fax:810-732-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2887435Medicaid
237136Medicare Oscar/Certification
1018493OtherMI-COMMERCIAL NUMBER
126718OtherMI-COMMERCIAL NUMBER
=========094OtherMI-CHAMPUS
126683OtherMI-COMMERCIAL NUMBER
1998308OtherMI-COMMERCIAL NUMBER
=========070OtherMI-CHAMPUS
MI152887435Medicaid
MI2887435Medicaid
0E80300OtherMI-COMMERCIAL NUMBER
113414024DOtherMI-COMMERCIAL NUMBER
MI34020347Medicaid
0E803OtherMI-COMMERCIAL NUMBER
109673OtherMI-COMMERCIAL NUMBER
237136OtherMI-COMMERCIAL NUMBER
=========000OtherMI-COMMERCIAL NUMBER
1015680-0001OtherMI-COMMERCIAL NUMBER
=========OtherMI-COMMERCIAL NUMBER
237136Medicare Oscar/Certification