Provider Demographics
NPI:1558398479
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 OFFICIAL
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:402-434-8081
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 1:8055 O ST
Practice Address - Street 2:SUITE 111
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2565
Practice Address - Country:US
Practice Address - Phone:402-434-8081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
287060Medicare Oscar/Certification
287060OtherNE-COMMERCIAL NUMBER
0450OtherNE-COMMERCIAL NUMBER
287060Medicare Oscar/Certification
1018680OtherNE-COMMERCIAL NUMBER
6000288OtherNE-COMMERCIAL NUMBER
013100POtherNE-COMMERCIAL NUMBER
ANC015OtherNE-COMMERCIAL NUMBER
=========02OtherNE-COMMERCIAL NUMBER
NE=========02Medicaid
GA0942OtherNE-COMMERCIAL NUMBER
83186OtherNE-COMMERCIAL NUMBER
=========OtherNE-COMMERCIAL NUMBER
113414024DOtherNE-COMMERCIAL NUMBER
235397OtherNE-COMMERCIAL NUMBER