1710919998 NPI number — CENTERWELL CERTIFIED HEALTHCARE CORP.

Table of content: (NPI 1710919998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710919998 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:
1710919998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2023
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:
4030 MOORPARK AVE
Provider Second Line Business Practice Location Address:
SUITE 251
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95117-1807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-261-2801
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 SIGNATORY
Authorized Official Telephone Number:
408-261-2801

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: 028758 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 114543 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 095190 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 106825016 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 235392 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5868461 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11-3414024 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3722 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 565800 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 070000279 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113414024 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55-7052 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 564469 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: ANC015 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 013100P . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 557052 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: HHA07842F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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