1518990258 NPI number — CENTERWELL CERTIFIED HEALTHCARE CORP.

Table of content: (NPI 1518990258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518990258 NPI number — CENTERWELL CERTIFIED HEALTHCARE CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTERWELL CERTIFIED HEALTHCARE CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTERWELL HOME HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518990258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6330 SPRINT PKWY STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66211-1157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 NOEL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42240-1386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-885-7887
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED SIGNATORY
Authorized Official Telephone Number:
270-885-7887

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000054236 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15324 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34003244 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7405017 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112135 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: ANC015 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000028220 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41024027 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60800-62 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9894 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 120243 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 187124 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42002246 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109673 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17000241 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1050333 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45341179 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 94420 . This is a "G2" identifier . This identifiers is of the category "OTHER".




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