Provider Demographics
NPI:1841229515
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:352-402-0660
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 1:311 SE 17TH PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5224
Practice Address - Country:US
Practice Address - Phone:352-402-0660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
070417OtherG2
112645333OtherG2
1013971OtherG2
00011327202OtherG2
107937324OtherG2
080053OtherG2
095190OtherG2
11-3414024OtherG2
107512OtherG2
013100POtherG2
020100OtherG2
112802024OtherG2
146544OtherG2
020100OtherG2
11-3414024OtherG2
=========COtherG2
00011327202OtherG2
107937324OtherG2
112645333OtherG2
=========009OtherG2