1619909884 NPI number — CENTERWELL CERTIFIED HEALTHCARE CORP.

Table of content: (NPI 1619909884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619909884 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:
1619909884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2023
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:
2120 S WALDRON RD BLDG C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72903-3689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-452-0424
Provider Business Practice Location Address Fax Number:
479-452-0960
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
479-452-0424

Provider Taxonomy Codes

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

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

  • Identifier: 129056732 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013100P . This is a "AR-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112135 . This is a "AR-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 138833742 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129054514 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138832757 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145489757 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 047038 . This is a "AR-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 115712 . This is a "AR-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 129054514 (AR) , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138789752 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145450752 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145487738 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145688732 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 140555765 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0564382 . This is a "AR-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11341402450 . This is a "AR-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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