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	1020850	OTHER	G2
2	3722	OTHER	G2
3	4546469	OTHER	G2
4	510-07956	OTHER	G2
5	510-50592	OTHER	G2
6	6000048	OTHER	G2
7	79298	OTHER	G2
8	017152	OTHER	G2
9	51041146	OTHER	G2
10	2352450	OTHER	G2
11	51526124	OTHER	G2
12	ANC015	OTHER	G2
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	013100P	OTHER	G2
15	07959	OTHER	G2
16	7349528	OTHER	G2

General Provider Information

NPI Number	:	1275564437
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	:	1011 W FORT WILLIAMS ST STE 1011
Second Line	:
City	:	SYLACAUGA
State	:	AL
Zip	:	35150-2301
Country	:	US
Telephone Number	:	256-249-4363
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED SIGNATORY
Name	:	JOHN NICHOLS
Credential	:
Telephone Number	:	256-249-4363

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	10/18/2023

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Directions to “CENTERWELL CERTIFIED HEALTHCARE CORP. ” Practice Location

Language	Start Address	Practice Location

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