Provider Demographics
NPI:1801825187
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:253-475-6862
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 1:4020 S 56TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2615
Practice Address - Country:US
Practice Address - Phone:253-475-6862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
135183OtherWA-COMMERCIAL NUMBER
651-YIOtherWA-COMMERCIAL NUMBER
7271048OtherWA-COMMERCIAL NUMBER
11-3414024OtherWA-COMMERCIAL NUMBER
2223178OtherWA-COMMERCIAL NUMBER
321563001OtherWA-COMMERCIAL NUMBER
321563003OtherWA-COMMERCIAL NUMBER
113414024OtherWA-COMMERCIAL NUMBER
1014837OtherWA-COMMERCIAL NUMBER
WA9041583Medicaid
013100POtherWA-COMMERCIAL NUMBER
1173OtherWA-BLUE CROSS
300066150OtherWA-COMMERCIAL NUMBER
507031OtherWA-COMMERCIAL NUMBER
565800OtherWA-COMMERCIAL NUMBER
WA9041161Medicaid
1014837OtherWA-COMMERCIAL NUMBER
7271048OtherWA-COMMERCIAL NUMBER
=========OtherWA-CHAMPUS
507031Medicare Oscar/Certification