Healthcare Provider Details

I. General information

NPI: 1316974272
Provider Name (Legal Business Name): CENTERWELL CERTIFIED HEALTHCARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 TATE BLVD SE STE 304
HICKORY NC
28602-1469
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 828-322-6131
  • 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
Identifier42706-30
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 2
Identifier600055
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 3
Identifier106825096
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 4
Identifier2241199
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 5
Identifier6003419
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 6
Identifier013100P
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 7
Identifier0420N
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 8
Identifier3408703
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 9
Identifier347300
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 10
Identifier1316974272
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 11
Identifier3407300
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 12
Identifier0076F
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 13
Identifier2241203
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 14
Identifier12416
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 15
Identifier0094Q
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 16
Identifier2118388
Identifier TypeOTHER
Identifier State
Identifier IssuerG2
# 17
Identifier259837
Identifier TypeOTHER
Identifier State
Identifier IssuerG2

VIII. Authorized Official

Name: JOHN W NICHOLS
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 828-322-6131