Provider Demographics
NPI:1861428567
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:805-544-4402
Mailing Address - Street 1:6330 SPRINT PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1171
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:805 AEROVISTA PL STE 204
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7920
Practice Address - Country:US
Practice Address - Phone:440-280-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
050000095OtherCA-COMMERCIAL NUMBER
564457OtherCA-COMMERCIAL NUMBER
05-7203OtherCA-COMMERCIAL NUMBER
ZZZ35475ZOtherCA-BLUE SHIELD
5868461OtherCA-COMMERCIAL NUMBER
013100POtherCA-COMMERCIAL NUMBER
057203OtherCA-COMMERCIAL NUMBER
CAHHA07203GMedicaid
106825020OtherCA-COMMERCIAL NUMBER
ANC015OtherCA-COMMERCIAL NUMBER
GA0592OtherCA-COMMERCIAL NUMBER
05-7203OtherCA-BLUE CROSS
05-7203OtherCA-COMMERCIAL NUMBER
564457OtherCA-COMMERCIAL NUMBER