Provider Demographics
NPI:1891725693
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:770-998-1393
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 1:1303 HIGHTOWER TRL
Practice Address - Street 2:SUITE 105
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-2919
Practice Address - Country:US
Practice Address - Phone:770-998-1393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
827390OtherG2
112135OtherG2
19001OtherG2
79298OtherG2
GA2202OtherG2
106825038OtherG2
113414024GOtherG2
52655785OtherG2
7803376OtherG2
GA797880700AMedicaid
1016875OtherG2
2886106OtherG2
146544OtherG2
510-07956OtherG2
ANC015OtherG2
7803376OtherG2
ANC015OtherG2
=========OtherG2