Provider Demographics
NPI:1356370639
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:304-346-9667
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 1:4825 MACCORKLE AVE SW STE F
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1365
Practice Address - Country:US
Practice Address - Phone:304-346-9667
Practice Address - Fax:304-346-9717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
001741773OtherWV-COMMERCIAL NUMBER
113414024-03OtherWV-COMMERCIAL NUMBER
2118364OtherWV-COMMERCIAL NUMBER
7723012OtherWV-COMMERCIAL NUMBER
ANC015OtherWV-COMMERCIAL NUMBER
920155OtherWV-COMMERCIAL NUMBER
0003019448OtherWV-COMMERCIAL NUMBER
517048OtherWV-COMMERCIAL NUMBER
WV0005018000Medicaid
013100POtherWV-COMMERCIAL NUMBER
235397OtherWV-COMMERCIAL NUMBER
28689OtherWV-COMMERCIAL NUMBER
600055OtherWV-COMMERCIAL NUMBER
WV0160941000Medicaid
WV5018000Medicaid
8413-90OtherWV-COMMERCIAL NUMBER
7723012OtherWV-COMMERCIAL NUMBER
=========OtherWV-COMMERCIAL NUMBER
=========062OtherWV-CHAMPUS
ANC015OtherWV-COMMERCIAL NUMBER
28689OtherWV-COMMERCIAL NUMBER