Provider Demographics
NPI:1194753194
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:VICE PRESIDENT OF LICENSURE
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:434-846-5219
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 1:20715 TIMBERLAKE RD STE 106
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7217
Practice Address - Country:US
Practice Address - Phone:434-846-5219
Practice Address - Fax:434-528-4963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004970985Medicaid
VA1194753194Medicaid
7049027OtherG2
VA8750815Medicaid
VA008750815Medicaid
2118448OtherG2
314390OtherG2
1016429OtherG2
VA004947606Medicaid
0003302145OtherG2
112214OtherG2
497429OtherG2
600055OtherG2
90291OtherG2
VA008700737Medicaid
ANC015OtherG2
VA008771294Medicaid
227654OtherG2
51940OtherG2
497597Medicare Oscar/Certification
497597Medicare Oscar/Certification