Provider Demographics
NPI:1548292717
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:765-282-0351
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 1:400 N HIGH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-1646
Practice Address - Country:US
Practice Address - Phone:765-282-0351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000255408OtherIN-COMMERCIAL NUMBER
1020650OtherIN-COMMERCIAL NUMBER
109673OtherIN-COMMERCIAL NUMBER
5076005OtherIN-COMMERCIAL NUMBER
157180OtherIN-COMMERCIAL NUMBER
2171467OtherIN-COMMERCIAL NUMBER
100264810OtherIN-COMMERCIAL NUMBER
IN100265320CMedicaid
GA0630OtherIN-COMMERCIAL NUMBER
0003302145OtherIN-COMMERCIAL NUMBER
ANC015OtherIN-COMMERCIAL NUMBER
IN100264810AMedicaid
013100POtherIN-COMMERCIAL NUMBER
IN200400970CMedicaid
8413-90OtherIN-COMMERCIAL NUMBER
=========089OtherIN-CHAMPUS
=========111OtherIN-CHAMPUS
IN100264810AMedicaid
IN200400970CMedicaid