Provider Demographics
NPI:1124059688
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:W
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-362-7578
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 1:5238 VALLEYPOINTE PKWY STE 1B
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-3066
Practice Address - Country:US
Practice Address - Phone:540-362-7578
Practice Address - Fax:540-362-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118448OtherG2
227654OtherG2
600055OtherG2
1014588OtherG2
113414024GOtherG2
0003302145OtherG2
VA8750165Medicaid
VA004974298Medicaid
7049027OtherG2
VA004947371Medicaid
VA008750165Medicaid
VA008700630Medicaid
VA008771286Medicaid
VA1124059688Medicaid
42706-30OtherG2
497429OtherG2
ANCO15OtherG2
VA004947371Medicaid
VA004947371Medicaid