Provider Demographics
NPI:1558391680
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:281-446-5366
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 1:9810 FM 1960 BYPASS RD W
Practice Address - Street 2:SUITE 215
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3502
Practice Address - Country:US
Practice Address - Phone:281-446-5366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
013100POtherTX-COMMERCIAL NUMBER
TX001002269Medicaid
020100OtherTX-COMMERCIAL NUMBER
11-3414024OtherTX-COMMERCIAL NUMBER
113414024OtherTX-COMMERCIAL NUMBER
300066126OtherTX-COMMERCIAL NUMBER
457264OtherTX-COMMERCIAL NUMBER
0300339OtherTX-COMMERCIAL NUMBER
2193368OtherTX-COMMERCIAL NUMBER
114543OtherTX-COMMERCIAL NUMBER
1020575OtherTX-COMMERCIAL NUMBER
TX1364945-03Medicaid
TX136494503Medicaid
TX1662975-01Medicaid
564522OtherTX-COMMERCIAL NUMBER
TXDMEH09152Medicaid
235397OtherTX-COMMERCIAL NUMBER
TXDMEH09152Medicaid
564522OtherTX-COMMERCIAL NUMBER
457264Medicare Oscar/Certification