Provider Demographics
NPI:1235161407
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 OFFICIAL
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:501-525-5888
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 1:4328 CENTRAL AVE
Practice Address - Street 2:SUITE E
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-5907
Practice Address - Country:US
Practice Address - Phone:501-525-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR138834742(AR)Medicaid
AR145451757Medicaid
17029OtherAR-COMMERCIAL NUMBER
AR129060732Medicaid
AR145486738Medicaid
AR130046752Medicaid
AR138834742Medicaid
AR145452752Medicaid
AR145689732Medicaid
013100POtherAR-COMMERCIAL NUMBER
AR129062514Medicaid
0564382OtherAR-COMMERCIAL NUMBER
AR129062514 (AR)Medicaid
0003019448OtherAR-COMMERCIAL NUMBER
047105OtherAR-COMMERCIAL NUMBER
11341402450OtherAR-COMMERCIAL NUMBER
AR130045757Medicaid
AR145452752Medicaid
AR145486738Medicaid
AR145689732Medicaid