Provider Demographics
NPI:1447289723
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:304-424-7172
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 1:39 12TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4339
Practice Address - Country:US
Practice Address - Phone:304-424-7172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118366OtherWV-COMMERCIAL NUMBER
WV4498000Medicaid
013100POtherWV-COMMERCIAL NUMBER
OH0800833Medicaid
WV0922407Medicaid
WV0004498000Medicaid
0003019448OtherWV-COMMERCIAL NUMBER
001741770OtherWV-COMMERCIAL NUMBER
009556OtherWV-COMMERCIAL NUMBER
OH0922407Medicaid
113414024-02OtherWV-COMMERCIAL NUMBER
300066156OtherWV-COMMERCIAL NUMBER
WV3810000153Medicaid
504OtherWV-COMMERCIAL NUMBER
517087OtherWV-COMMERCIAL NUMBER
235397OtherWV-COMMERCIAL NUMBER
WV0004498000Medicaid
WV3810000153Medicaid
013100POtherWV-COMMERCIAL NUMBER
WV0922407Medicaid
WV0004498000Medicaid