Provider Demographics
NPI:1952337651
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:520-731-1333
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 1:5255 E WILLIAMS CIR STE 6400
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-7718
Practice Address - Country:US
Practice Address - Phone:520-731-1333
Practice Address - Fax:520-731-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
11-3414024OtherAZ-COMMERCIAL NUMBER
AZ333724Medicaid
013100POtherAZ-COMMERCIAL NUMBER
2096892OtherAZ-COMMERCIAL NUMBER
6000055OtherAZ-COMMERCIAL NUMBER
00011327202OtherAZ-COMMERCIAL NUMBER
106825011OtherAZ-COMMERCIAL NUMBER
3014811OtherAZ-COMMERCIAL NUMBER
AZ351586Medicaid
AZ0701490OtherAZ-COMMERCIAL NUMBER
037036OtherAZ-COMMERCIAL NUMBER
AZ333724-23Medicaid
1015524OtherAZ-COMMERCIAL NUMBER
7280276OtherAZ-COMMERCIAL NUMBER
ANC015OtherAZ-COMMERCIAL NUMBER
702022OtherAZ-COMMERCIAL NUMBER
8413-90OtherAZ-COMMERCIAL NUMBER
8413-90OtherAZ-COMMERCIAL NUMBER
7280276OtherAZ-COMMERCIAL NUMBER