Provider Demographics
NPI:1265483416
Name:BWB SUNBELT HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:BWB SUNBELT HOME HEALTH SERVICES LLC
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:915-881-8129
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 1:7500 VISCOUNT BLVD
Practice Address - Street 2:SUITE 156
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-5638
Practice Address - Country:US
Practice Address - Phone:915-881-8129
Practice Address - Fax:915-881-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014427251E00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX023643201Medicaid
TX45D0674070OtherCLIA
TX001002454OtherMDCP
TX02364320-2OtherCSHCN
TX457513Medicare Oscar/Certification
TX45D0674070OtherCLIA