Provider Demographics
NPI:1225064934
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:262-636-9036
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 1:6233 BANKERS ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-9700
Practice Address - Country:US
Practice Address - Phone:262-636-9036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41506200Medicaid
WI41506200Medicaid
GA0585OtherWI-COMMERCIAL NUMBER
=========OtherWI-COMMERCIAL NUMBER
ANC015OtherWI-COMMERCIAL NUMBER
527098OtherWI-COMMERCIAL NUMBER
6000120OtherWI-COMMERCIAL NUMBER
=========071OtherWI-CHAMPUS
=========096OtherWI-CHAMPUS
527098Medicare Oscar/Certification
1020083OtherWI-COMMERCIAL NUMBER
109673OtherWI-COMMERCIAL NUMBER
8413-90OtherWI-COMMERCIAL NUMBER
565800OtherWI-COMMERCIAL NUMBER
WI41506200Medicaid
7751005OtherWI-COMMERCIAL NUMBER
=========017OtherWI-COMMERCIAL NUMBER
41532800OtherWI-COMMERCIAL NUMBER