Provider Demographics
NPI:1780614412
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:717-291-5943
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 1:1860 CHARTER LANE
Practice Address - Street 2:SUITE 106
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6755
Practice Address - Country:US
Practice Address - Phone:717-291-5943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1006932660068Medicaid
397237Medicare Oscar/Certification
565800OtherG2
2118415OtherG2
397532OtherG2
PA000000145803Medicaid
30941OtherG2
7172099OtherG2
PA1006932660068Medicaid
PA60621Medicaid
34253OtherG2
0001242000OtherG2
397422Other1A
397237Medicare Oscar/Certification
2212459OtherG2
235397OtherG2
600055OtherG2
1017464OtherG2
PA1481266Medicaid
1500992OtherG2