Provider Demographics
NPI:1184653461
Name:CENTERWELL CERTIFIED HEALTHCARE CORP.
Entity type:Organization
Organization Name:CENTERWELL CERTIFIED HEALTHCARE CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:509-464-4970
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 1:8502 N NEVADA ST
Practice Address - Street 2:STE. 2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-7395
Practice Address - Country:US
Practice Address - Phone:509-464-4970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
013100POtherWA-COMMERCIAL NUMBER
WA9041120Medicaid
300066148OtherWA-COMMERCIAL NUMBER
507075OtherWA-COMMERCIAL NUMBER
565800OtherWA-COMMERCIAL NUMBER
ID806765300Medicaid
WA9041559Medicaid
0010000039OtherWA-COMMERCIAL NUMBER
113414024OtherWA-COMMERCIAL NUMBER
2223178OtherWA-COMMERCIAL NUMBER
321563003OtherWA-COMMERCIAL NUMBER
321563001OtherWA-COMMERCIAL NUMBER
132302OtherWA-COMMERCIAL NUMBER
14444OtherWA-COMMERCIAL NUMBER
1018037OtherWA-COMMERCIAL NUMBER
1173OtherWA-BLUE CROSS
321563001OtherWA-COMMERCIAL NUMBER
321563003OtherWA-COMMERCIAL NUMBER
WA9041120Medicaid
WA9041559Medicaid