1194757468 NPI number — CENTERWELL CERTIFIED HEALTHCARE CORP.

Table of content: MIRELLA CALLE (NPI 1063164366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194757468 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:
1194757468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2024
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:
7101 NORTHLAND CIR N STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55428-1517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-416-0289
Provider Business Practice Location Address Fax Number:
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:
651-636-6330

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: 071755000 . This is a "MN-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 109673 . This is a "MN-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 169027 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 565732 . This is a "MN-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 071755000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 169027 . This is a "MN-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41525000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41532800 . This is a "MN-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 106825087 . This is a "MN-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 247145 . This is a "MN-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41525000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5900033 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113414024D . This is a "MN-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5900031 . This is a "MN-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 013100P . This is a "MN-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4614OL . This is a "MN-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4614OL , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5900033 . This is a "MN-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com