1720010010 NPI number — CENTERWELL CERTIFIED HEALTHCARE CORP.

Table of content: (NPI 1720010010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720010010 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:
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:
1720010010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2023
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:
201 SECURITY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANNAPOLIS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28083-2757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-933-1001
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:
W
Authorized Official Title or Position:
AUTHORIZED SIGNATORY
Authorized Official Telephone Number:
704-933-1001

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: 0094Q . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100004 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: ANC015 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0076F . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 600055 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12416 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6600486 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2118504 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 259837 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42707-30 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7320052 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3407170 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3408703 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 347170 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42706-30 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7701350 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 79298 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 106825091 . This is a "G2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1720010010 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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