Provider Demographics
NPI:1861428575
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 OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-326-5729
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 1:804 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4222
Practice Address - Country:US
Practice Address - Phone:580-326-8376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100260400MMedicaid
100260400BOtherOK-COMMERCIAL NUMBER
ANC015OtherOK-COMMERCIAL NUMBER
OK100260400 EMedicaid
OK100260400LMedicaid
OK100260400UMedicaid
7559146OtherOK-COMMERCIAL NUMBER
013100POtherOK-COMMERCIAL NUMBER
1020616OtherOK-COMMERCIAL NUMBER
100260400COtherOK-COMMERCIAL NUMBER
OK100260400EMedicaid
377146OtherOK-COMMERCIAL NUMBER
OK100260400AMedicaid
17029OtherOK-COMMERCIAL NUMBER
2366169OtherOK-COMMERCIAL NUMBER
B45126453331OtherOK-COMMERCIAL NUMBER
000377146002OtherOK-COMMERCIAL NUMBER
1020616OtherOK-COMMERCIAL NUMBER
OK100260400LMedicaid
OK100260400LMedicaid