1558343145 NPI number — CENTERWELL HEALTH SERVICES USA LLC

Table of content: (NPI 1558343145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558343145 NPI number — CENTERWELL HEALTH SERVICES USA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTERWELL HEALTH SERVICES USA LLC
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:
Provider Other Organization Name Type Code:
6
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:
1558343145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6330 SPRINT PARKWAY
Provider Second Line Business Mailing Address:
SUITE 300
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:
913-814-2206
Provider Business Mailing Address Fax Number:
913-814-2029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 W FOREST AVE.
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HOMERVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-636-3001
Provider Business Practice Location Address Fax Number:
912-210-5608
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
LLOYD
Authorized Official Middle Name:
KIRK
Authorized Official Title or Position:
PRESIDENT, HOME HEALTH
Authorized Official Telephone Number:
502-580-1069

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  092275H , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000775541A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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