MEDICARE: CENTERWELL CERTIFIED HEALTHCARE CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	071755000	OTHER	MN-COMMERCIAL NUMBER
2	109673	OTHER	MN-COMMERCIAL NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	565732	OTHER	MN-COMMERCIAL NUMBER
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	169027	OTHER	MN-COMMERCIAL NUMBER
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	41532800	OTHER	MN-COMMERCIAL NUMBER
9	106825087	OTHER	MN-COMMERCIAL NUMBER
10	247145	OTHER	MN-COMMERCIAL NUMBER
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	113414024D	OTHER	MN-COMMERCIAL NUMBER
14	5900031	OTHER	MN-COMMERCIAL NUMBER
15	013100P	OTHER	MN-COMMERCIAL NUMBER
16	4614OL	OTHER	MN-COMMERCIAL NUMBER
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	5900033	OTHER	MN-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1194757468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERWELL CERTIFIED HEALTHCARE CORP.

Provider Business Mailing Address
First Line	:	6330 SPRINT PKWY STE 300
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7101 NORTHLAND CIR N STE 101
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-1517
Country	:	US
Telephone Number	:	763-416-0289
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JOHN NICHOLS
Credential	:
Telephone Number	:	651-636-6330

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/22/2024

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Directions to “CENTERWELL CERTIFIED HEALTHCARE CORP. ” Practice Location

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