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General NPI Number Information
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NPI Number | 1861428567
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Entity Type | Organization
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Legal Business Name | CENTERWELL CERTIFIED HEALTHCARE CORP.
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 805 AEROVISTA PL STE 204
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7920
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Country | US
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Telephone | 440-280-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 6330 SPRINT PKWY STE 400
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City | OVERLAND PARK
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State | KS
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Zip | 66211-1171
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED SIGNATORY
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Name | JOHN NICHOLS
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Credential |
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Telephone | 805-544-4402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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