Healthcare Provider Details

I. General information

NPI: 1538190087
Provider Name (Legal Business Name): CENTERWELL CERTIFIED HEALTHCARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MARTINE ST STE 104
FALL RIVER MA
02723-1500
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 508-672-0675
  • 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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0604313
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 2
Identifier60-00179
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 3
Identifier702022
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 4
Identifier63102610611H
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 5
Identifier801438
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 6
Identifier1020028
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 7
Identifier3267811
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 8
Identifier0606308/1030200
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 9
Identifier0606391
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 10
Identifier0008212
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 11
IdentifierGA0745
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 12
Identifier013100P
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 13
Identifier335394
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 14
IdentifierANC015
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 15
Identifier0606391
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 16
Identifier565800
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 17
Identifier227260
Identifier TypeOTHER
Identifier State
Identifier IssuerG2

VIII. Authorized Official

Name: JOHN NICHOLS
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 508-672-0675