Provider Demographics
NPI:1437185139
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:602-992-0709
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 1:16620 N 40TH ST
Practice Address - Street 2:SUITE D4
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3350
Practice Address - Country:US
Practice Address - Phone:602-992-0709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0003302145OtherAZ-COMMERCIAL NUMBER
3014811OtherAZ-COMMERCIAL NUMBER
564395OtherAZ-COMMERCIAL NUMBER
013100POtherAZ-COMMERCIAL NUMBER
ANC015OtherAZ-COMMERCIAL NUMBER
037037OtherAZ-COMMERCIAL NUMBER
106825010OtherAZ-COMMERCIAL NUMBER
AZ0701490OtherAZ-COMMERCIAL NUMBER
11-3414024OtherAZ-COMMERCIAL NUMBER
1015374OtherAZ-COMMERCIAL NUMBER
7280276OtherAZ-COMMERCIAL NUMBER
321563003OtherAZ-COMMERCIAL NUMBER
AZ333724-23Medicaid
235392OtherAZ-COMMERCIAL NUMBER
AZ333724Medicaid
GA0005OtherAZ-COMMERCIAL NUMBER
AZ0701490OtherAZ-COMMERCIAL NUMBER
GA0005OtherAZ-COMMERCIAL NUMBER