Provider Demographics
NPI:1710919071
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:913-906-0522
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 1:11600 COLLEGE BLVD STE 230
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2786
Practice Address - Country:US
Practice Address - Phone:913-906-0522
Practice Address - Fax:
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
013100POtherKS-COMMERCIAL NUMBER
KS100241990BMedicaid
112135OtherKS-COMMERCIAL NUMBER
KS5857539002Medicaid
109673OtherKS-COMMERCIAL NUMBER
235394OtherKS-COMMERCIAL NUMBER
003302145OtherKS-COMMERCIAL NUMBER
KS100060500BMedicaid
1016434OtherKS-COMMERCIAL NUMBER
113414024DOtherKS-COMMERCIAL NUMBER
113414024EOtherKS-COMMERCIAL NUMBER
177179OtherKS-COMMERCIAL NUMBER
29109OtherKS-COMMERCIAL NUMBER
5337491OtherKS-COMMERCIAL NUMBER
565800OtherKS-COMMERCIAL NUMBER
KS011180Medicaid
MO581942109Medicaid
KS100241990BMedicaid
29109OtherKS-COMMERCIAL NUMBER
KS011180Medicaid