Provider Demographics
NPI:1316973019
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:330-644-4447
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 1:1531 BOETTLER RD STE E
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7765
Practice Address - Country:US
Practice Address - Phone:330-644-4447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0208000Medicaid
OH0208000Medicaid
0565040OtherOH-COMMERCIAL NUMBER
19001OtherOH-COMMERCIAL NUMBER
=========045OtherOH-CHAMPUS
115712OtherOH-COMMERCIAL NUMBER
367159OtherOH-COMMERCIAL NUMBER
OH0208000Medicaid
367159Medicare Oscar/Certification
000000251690OtherOH-COMMERCIAL NUMBER
235397OtherOH-COMMERCIAL NUMBER
355OtherOH-COMMERCIAL NUMBER
4439557OtherOH-COMMERCIAL NUMBER
=========OtherOH-COMMERCIAL NUMBER
1013821OtherOH-COMMERCIAL NUMBER
112345333006OtherOH-COMMERCIAL NUMBER
113414024DOtherOH-COMMERCIAL NUMBER
146544OtherOH-COMMERCIAL NUMBER
=========-17OtherOH-COMMERCIAL NUMBER
=========006OtherOH-COMMERCIAL NUMBER