Provider Demographics
NPI:1295761997
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 OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-345-3754
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 1:4401 MASTHEAD ST NE STE 105
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4682
Practice Address - Country:US
Practice Address - Phone:505-345-3754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000A8575Medicaid
NM000F1512Medicaid
327070OtherNM-COMMERCIAL NUMBER
60-03419OtherNM-COMMERCIAL NUMBER
112207OtherNM-COMMERCIAL NUMBER
28689OtherNM-COMMERCIAL NUMBER
827390OtherNM-COMMERCIAL NUMBER
013100POtherNM-COMMERCIAL NUMBER
54826OtherNM-COMMERCIAL NUMBER
8413-90OtherNM-COMMERCIAL NUMBER
ANC015OtherNM-COMMERCIAL NUMBER
NM0000N1425Medicaid
146544OtherNM-COMMERCIAL NUMBER
565800OtherNM-COMMERCIAL NUMBER
689703OtherNM-COMMERCIAL NUMBER
NMN1425Medicaid
300066102OtherNM-COMMERCIAL NUMBER
8413-90OtherNM-COMMERCIAL NUMBER
=========OtherNM-COMMERCIAL NUMBER