Provider Demographics
NPI:1689600371
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:402-343-9433
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 1:1045 N 115TH ST STE 350
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4415
Practice Address - Country:US
Practice Address - Phone:402-343-9433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0925024Medicaid
ANC015OtherNE-COMMERCIAL NUMBER
GA0734OtherNE-COMMERCIAL NUMBER
IA0925024Medicaid
NE10662334Medicaid
6000478OtherNE-COMMERCIAL NUMBER
0450OtherNE-COMMERCIAL NUMBER
83186OtherNE-COMMERCIAL NUMBER
013100POtherNE-COMMERCIAL NUMBER
1018667OtherNE-COMMERCIAL NUMBER
NE945395002Medicaid
287038OtherNE-COMMERCIAL NUMBER
10183001OtherNE-COMMERCIAL NUMBER
67129OtherNE-COMMERCIAL NUMBER
=========OtherNE-COMMERCIAL NUMBER
NE10662334Medicaid
=========036OtherNE-CHAMPUS
NE0925024Medicaid
NE=========01Medicaid