Provider Demographics
NPI:1659302164
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:304-733-9430
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 1:3198 US ROUTE 60 STE A
Practice Address - Street 2:
Practice Address - City:ONA
Practice Address - State:WV
Practice Address - Zip Code:25545-9507
Practice Address - Country:US
Practice Address - Phone:304-733-9430
Practice Address - Fax:304-733-9439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005018002Medicaid
001741776OtherWV-COMMERCIAL NUMBER
113414024-00OtherWV-COMMERCIAL NUMBER
OH2050766Medicaid
2118392OtherWV-COMMERCIAL NUMBER
WV0005018-002Medicaid
109673OtherWV-COMMERCIAL NUMBER
WV5018002Medicaid
202041OtherWV-COMMERCIAL NUMBER
WV2050766Medicaid
235397OtherWV-COMMERCIAL NUMBER
WV3810000157Medicaid
013100POtherWV-COMMERCIAL NUMBER
113414024OtherWV-COMMERCIAL NUMBER
517048OtherWV-COMMERCIAL NUMBER
517126Medicare Oscar/Certification
OH2050766Medicaid
2118392OtherWV-COMMERCIAL NUMBER
=========-21OtherWV-COMMERCIAL NUMBER
WV5018002Medicaid
517126Medicare Oscar/Certification