Provider Demographics
NPI:1518991215
Name:CENTERWELL HEALTH SERVICES (CERTIFIED), INC.
Entity Type:Organization
Organization Name:CENTERWELL HEALTH SERVICES (CERTIFIED), INC.
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:850-862-3240
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 1:1140 N EGLIN PKWY STE 1
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1227
Practice Address - Country:US
Practice Address - Phone:850-862-3240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
6000055OtherG2
112645333OtherG2
689825OtherG2
7342031OtherG2
107937330OtherG2
11-3414024OtherG2
113414024GOtherG2
79298OtherG2
1016439OtherG2
2338051OtherG2
7349528OtherG2
146544OtherG2
2117437OtherG2
107240OtherG2
249710OtherG2
6000055OtherG2
11-3414024OtherG2
2117437OtherG2
146544OtherG2
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