Provider Demographics
NPI:1700821097
Name:CENTERWELL HEALTH SERVICES CERTIFIED, INC.
Entity Type:Organization
Organization Name:CENTERWELL HEALTH SERVICES CERTIFIED, INC.
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:941-749-2990
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 1:5265 OFFICE PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-3441
Practice Address - Country:US
Practice Address - Phone:941-749-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013513OtherG2
115712OtherG2
235397OtherG2
321563003OtherG2
6000055OtherG2
080053OtherG2
2117419OtherG2
689825OtherG2
00011327202OtherG2
11-3414024OtherG2
112645333OtherG2
146544OtherG2
249710OtherG2
095190OtherG2
2307500OtherG2
112645333OtherG2
146544OtherG2
=========064Other1H
11-3414024OtherG2
115712OtherG2