Provider Demographics
NPI:1144252313
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:317-915-1440
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 1:8606 ALLISONVILLE RD STE 350
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-5514
Practice Address - Country:US
Practice Address - Phone:317-915-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
013100POtherIN-COMMERCIAL NUMBER
IN100265320AMedicaid
0003302145OtherIN-COMMERCIAL NUMBER
IN200400970AMedicaid
1020025OtherIN-COMMERCIAL NUMBER
000000035875OtherIN-COMMERCIAL NUMBER
IN100263840Medicaid
109673OtherIN-COMMERCIAL NUMBER
113414024DOtherIN-COMMERCIAL NUMBER
000000106902OtherIN-COMMERCIAL NUMBER
100264810OtherIN-COMMERCIAL NUMBER
112135OtherIN-COMMERCIAL NUMBER
120243OtherIN-COMMERCIAL NUMBER
IN100263840AMedicaid
100263840AOtherIN-COMMERCIAL NUMBER
IN110263840AMedicaid
IN100265320AMedicaid
112135OtherIN-COMMERCIAL NUMBER
IN110263840AMedicaid
100264810OtherIN-COMMERCIAL NUMBER