Provider Demographics
NPI:1619909884
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:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-452-0424
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 1:2120 S WALDRON RD BLDG C
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3689
Practice Address - Country:US
Practice Address - Phone:479-452-0424
Practice Address - Fax:479-452-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129056732Medicaid
013100POtherAR-COMMERCIAL NUMBER
112135OtherAR-COMMERCIAL NUMBER
AR138833742Medicaid
AR129054514Medicaid
AR138832757Medicaid
AR145489757Medicaid
047038OtherAR-COMMERCIAL NUMBER
115712OtherAR-COMMERCIAL NUMBER
AR129054514 (AR)Medicaid
AR138789752Medicaid
AR145450752Medicaid
AR145487738Medicaid
AR145688732Medicaid
AR140555765Medicaid
0564382OtherAR-COMMERCIAL NUMBER
11341402450OtherAR-COMMERCIAL NUMBER
AR129056732Medicaid
AR145688732Medicaid
047038Medicare Oscar/Certification