Provider Demographics
NPI:1689604860
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:423-230-1000
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 1:2004 AMERICAN WAY
Practice Address - Street 2:SUITE 121
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5892
Practice Address - Country:US
Practice Address - Phone:423-230-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN447254Medicaid
60-20020OtherG2
113414024DOtherG2
GA0178OtherG2
0094420OtherG2
TN044-7254TNMedicaid
ANC015OtherG2
60-20010OtherG2
TN0094420Medicaid
112207OtherG2
34511OtherG2
TNQ033359Medicaid
44711OtherG2
564395OtherG2
013100POtherG2
447254OtherG2
TNTN0112Medicaid
=========OtherG2
34511OtherG2
TNTN0112Medicaid