Provider Demographics
NPI:1669406377
Name:CENTERWELL HEALTH SERVICES (CERTIFIED), INC.
Entity type:Organization
Organization Name:CENTERWELL HEALTH SERVICES (CERTIFIED), INC.
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:386-758-3490
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 1:419 SW STATE ROAD 247 STE 109
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-8318
Practice Address - Country:US
Practice Address - Phone:386-758-3490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
146544OtherG2
2117440OtherG2
11-3414024OtherG2
249710OtherG2
7342031OtherG2
013100POtherG2
070415OtherG2
095190OtherG2
107420OtherG2
689825OtherG2
080053OtherG2
112645333OtherG2
435459Other1A
6000055OtherG2
1016443OtherG2
113414024OtherG2
79298OtherG2
435459Other1A
689825OtherG2