Provider Demographics
NPI:1992734271
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:253-395-5133
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 1:20829 72ND AVE S
Practice Address - Street 2:SUITE 125
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1404
Practice Address - Country:US
Practice Address - Phone:253-395-5133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1014840OtherWA-COMMERCIAL NUMBER
507082OtherWA-COMMERCIAL NUMBER
WA9041567Medicaid
11-3414024OtherWA-COMMERCIAL NUMBER
113414024OtherWA-COMMERCIAL NUMBER
321563001OtherWA-COMMERCIAL NUMBER
112135OtherWA-COMMERCIAL NUMBER
17029OtherWA-COMMERCIAL NUMBER
2223178OtherWA-COMMERCIAL NUMBER
321563003OtherWA-COMMERCIAL NUMBER
WA9041112Medicaid
013100POtherWA-COMMERCIAL NUMBER
1173OtherWA-BLUE CROSS
135182OtherWA-COMMERCIAL NUMBER
235394OtherWA-COMMERCIAL NUMBER
300066149OtherWA-COMMERCIAL NUMBER
321563001OtherWA-COMMERCIAL NUMBER
=========-98002OtherWA-CHAMPUS
113414024OtherWA-COMMERCIAL NUMBER