1912934696 NPI number — CENTERWELL CERTIFIED HEALTHCARE CORP.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912934696 NPI number — CENTERWELL CERTIFIED HEALTHCARE CORP.

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 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:

1912934696

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

11/29/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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 First Line Business Practice Location Address:

88 ROUTE 6A

Provider Second Line Business Practice Location Address:

SUITE 101

Provider Business Practice Location Address City Name:

SANDWICH

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

02563-1866

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

508-888-2932

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

06/27/2006

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:

508-888-2932

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

• Identifier: 0606472 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: BXP003399 . This is a "G2" identifier . This identifiers is of the category "OTHER".
• Identifier: 013100P . This is a "G2" identifier . This identifiers is of the category "OTHER".
• Identifier: 106825067 . This is a "G2" identifier . This identifiers is of the category "OTHER".
• Identifier: 0604313 . This is a "G2" identifier . This identifiers is of the category "OTHER".
• Identifier: 3267811 . This is a "G2" identifier . This identifiers is of the category "OTHER".
• Identifier: 651-YI . This is a "G2" identifier . This identifiers is of the category "OTHER".
• Identifier: 702022 . This is a "G2" identifier . This identifiers is of the category "OTHER".
• Identifier: 227426 . This is a "G2" identifier . This identifiers is of the category "OTHER".
• Identifier: 235397 . This is a "G2" identifier . This identifiers is of the category "OTHER".
• Identifier: 01728165 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 1006932660068 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 60-00179 . 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: 801438 . This is a "G2" identifier . This identifiers is of the category "OTHER".
• Identifier: 1020035 . This is a "G2" identifier . This identifiers is of the category "OTHER".