Provider Demographics
NPI:1225064926
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:414-327-4553
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 1:10150 W NATIONAL AVE STE 150
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2145
Practice Address - Country:US
Practice Address - Phone:414-327-4553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
013100POtherWI-COMMERCIAL NUMBER
1020081OtherWI-COMMERCIAL NUMBER
527207OtherWI-COMMERCIAL NUMBER
565800OtherWI-COMMERCIAL NUMBER
6001113OtherWI-COMMERCIAL NUMBER
7751005OtherWI-COMMERCIAL NUMBER
061303OtherWI-COMMERCIAL NUMBER
109673OtherWI-COMMERCIAL NUMBER
6000120OtherWI-COMMERCIAL NUMBER
300066154OtherWI-COMMERCIAL NUMBER
235394OtherWI-COMMERCIAL NUMBER
235397OtherWI-COMMERCIAL NUMBER
41532800OtherWI-COMMERCIAL NUMBER
WI41532800Medicaid
=========134OtherWI-CHAMPUS
WI41532800Medicaid
=========OtherWI-COMMERCIAL NUMBER
061303OtherWI-COMMERCIAL NUMBER
6000120OtherWI-COMMERCIAL NUMBER
6000120OtherWI-COMMERCIAL NUMBER