Provider Demographics
NPI:1710919998
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:408-261-2801
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 1:4030 MOORPARK AVE
Practice Address - Street 2:SUITE 251
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1807
Practice Address - Country:US
Practice Address - Phone:408-261-2801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
028758OtherCA-COMMERCIAL NUMBER
114543OtherCA-COMMERCIAL NUMBER
095190OtherCA-COMMERCIAL NUMBER
106825016OtherCA-COMMERCIAL NUMBER
235392OtherCA-COMMERCIAL NUMBER
5868461OtherCA-COMMERCIAL NUMBER
11-3414024OtherCA-COMMERCIAL NUMBER
3722OtherCA-COMMERCIAL NUMBER
565800OtherCA-COMMERCIAL NUMBER
070000279OtherCA-COMMERCIAL NUMBER
113414024OtherCA-COMMERCIAL NUMBER
55-7052OtherCA-COMMERCIAL NUMBER
564469OtherCA-COMMERCIAL NUMBER
ANC015OtherCA-COMMERCIAL NUMBER
013100POtherCA-COMMERCIAL NUMBER
557052OtherCA-COMMERCIAL NUMBER
CAHHA07842FMedicaid
564469OtherCA-COMMERCIAL NUMBER
CAHHA07842FMedicaid