Healthcare Provider Details

I. General information

NPI: 1518991215
Provider Name (Legal Business Name): CENTERWELL HEALTH SERVICES (CERTIFIED), INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 N EGLIN PKWY STE 1
SHALIMAR FL
32579-1227
US

IV. Provider business mailing address

6330 SPRINT PKWY STE 300
OVERLAND PARK KS
66211-1157
US

V. Phone/Fax

Practice location:
  • Phone: 850-862-3240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN NICHOLS
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 850-862-3240