Provider Demographics
NPI:1437175338
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:W
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-594-9029
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 1:9009 PERIMETER WOODS DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-0040
Practice Address - Country:US
Practice Address - Phone:704-594-9029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0076FOtherG2
NC1437175338Medicaid
42706-30OtherG2
113414024OtherG2
2241306OtherG2
259837OtherG2
NC3407177Medicaid
347177OtherG2
600055OtherG2
12416OtherG2
2118366OtherG2
013100POtherG2
049002OtherG2
18618OtherG2
565800OtherG2
0094QOtherG2
1134141024GOtherG2
NC1437175338Medicaid
565800OtherG2
=========300Other1H
NC1437175338Medicaid