Healthcare Provider Details

I. General information

NPI: 1558394254
Provider Name (Legal Business Name): CENTERWELL CERTIFIED HEALTHCARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 EXECUTIVE PARK
LOUISVILLE KY
40207-4207
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 502-895-4213
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
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: 502-895-4213