Provider Demographics
NPI:1285661108
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:775-858-1900
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 1:1755 E PLUMB LN STE 159
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3683
Practice Address - Country:US
Practice Address - Phone:775-858-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002916002Medicaid
1018070OtherNV-COMMERCIAL NUMBER
145040OtherNV-COMMERCIAL NUMBER
NV58 16002Medicaid
013100POtherNV-COMMERCIAL NUMBER
NV30-16234Medicaid
11-3414024OtherNV-COMMERCIAL NUMBER
2187753OtherNV-COMMERCIAL NUMBER
NV29-16002Medicaid
297022OtherNV-COMMERCIAL NUMBER
300066104OtherNV-COMMERCIAL NUMBER
NV58-16002Medicaid
113414024FOtherNV-COMMERCIAL NUMBER
114543OtherNV-COMMERCIAL NUMBER
NV29 16002Medicaid
NV003016234Medicaid
3575153OtherNV-COMMERCIAL NUMBER
NV002916002Medicaid
NV58-16002Medicaid