Provider Demographics
NPI:1538198817
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:425-745-4345
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 1:728 134TH ST SW STE 203
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-5322
Practice Address - Country:US
Practice Address - Phone:425-745-4345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3865GEMedicaid
WA9041575Medicaid
WA9041112Medicaid
113414024OtherWA-COMMERCIAL NUMBER
WA9041138Medicaid
5340GEOtherWA-BLUE SHIELD
1173OtherWA-BLUE CROSS
2223178OtherWA-COMMERCIAL NUMBER
300066153OtherWA-COMMERCIAL NUMBER
3865GEOtherWA-BLUE SHIELD
135182OtherWA-COMMERCIAL NUMBER
7271048OtherWA-COMMERCIAL NUMBER
WA9019159Medicaid
1021032OtherWA-COMMERCIAL NUMBER
321563001OtherWA-COMMERCIAL NUMBER
ANC015OtherWA-COMMERCIAL NUMBER
ANC015OtherWA-COMMERCIAL NUMBER
300066153OtherWA-COMMERCIAL NUMBER