Provider Demographics
NPI:1912934696
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:508-888-2932
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 1:88 ROUTE 6A
Practice Address - Street 2:SUITE 101
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-1866
Practice Address - Country:US
Practice Address - Phone:508-888-2932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0606472Medicaid
BXP003399OtherG2
013100POtherG2
106825067OtherG2
0604313OtherG2
3267811OtherG2
651-YIOtherG2
702022OtherG2
227426OtherG2
235397OtherG2
NY01728165Medicaid
PA1006932660068Medicaid
60-00179OtherG2
ANC015OtherG2
801438OtherG2
1020035OtherG2
=========OtherG2
PA1006932660068Medicaid
651-YIOtherG2
MA0606472Medicaid