Provider Demographics
NPI:1629000989
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:269-381-5620
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 1:5148 LOVERS LN
Practice Address - Street 2:SUITE 210
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1572
Practice Address - Country:US
Practice Address - Phone:269-381-5620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1015681-0001OtherMI-COMMERCIAL NUMBER
126718OtherMI-COMMERCIAL NUMBER
1015680-0001OtherMI-COMMERCIAL NUMBER
07214-655201OtherMI-COMMERCIAL NUMBER
1018480OtherMI-COMMERCIAL NUMBER
113414024051OtherMI-COMMERCIAL NUMBER
013100POtherMI-COMMERCIAL NUMBER
0E802OtherMI-COMMERCIAL NUMBER
MI113414024052Medicaid
126683OtherMI-COMMERCIAL NUMBER
MI14558Medicaid
MI152887462Medicaid
109673OtherMI-COMMERCIAL NUMBER
MI15 4362705Medicaid
MI2887462Medicaid
0E802OtherMI-COMMERCIAL NUMBER
113414024051OtherMI-COMMERCIAL NUMBER
126718OtherMI-COMMERCIAL NUMBER
MI152887462Medicaid
MI15 4362705Medicaid