Provider Demographics
NPI:1265461545
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:304-255-5263
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 1:112 MELLON ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3536
Practice Address - Country:US
Practice Address - Phone:304-255-5263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
600055OtherWV-COMMERCIAL NUMBER
WV0005018001Medicaid
235397OtherWV-COMMERCIAL NUMBER
0005018001OtherWV-COMMERCIAL NUMBER
013100POtherWV-COMMERCIAL NUMBER
WV3810000154Medicaid
113414024-01OtherWV-COMMERCIAL NUMBER
1530955OtherWV-COMMERCIAL NUMBER
2118500OtherWV-COMMERCIAL NUMBER
001741723OtherWV-COMMERCIAL NUMBER
WV0005018-001Medicaid
PA100693266Medicaid
070032800OtherWV-COMMERCIAL NUMBER
WV5018001Medicaid
517048OtherWV-COMMERCIAL NUMBER
517125Medicare Oscar/Certification
WV3810000154Medicaid
WV0005018001Medicaid
WV0005018-001Medicaid
517125Medicare Oscar/Certification