MEDICARE: CENTERWELL CERTIFIED HEALTHCARE CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000015681	OTHER	G2
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	2273784	OTHER	G2
7	60-03419	OTHER	G2
8	013100P	OTHER	G2
9	120243	OTHER	G2
10	235397	OTHER	G2
11	702022	OTHER	G2
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	207038	OTHER	G2
14	565800	OTHER	G2
15	7706020	OTHER	G2
16	801438	OTHER	G2
17	17029	OTHER	G2

General Provider Information

NPI Number	:	1255362943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERWELL CERTIFIED HEALTHCARE CORP.

Provider Business Mailing Address
First Line	:	6330 SPRINT PKWY STE 300
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 ATLANTIC PL
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-2316
Country	:	US
Telephone Number	:	207-772-0954
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED SIGNATORY
Name	:	JOHN NICHOLS
Credential	:
Telephone Number	:	207-772-0954

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/21/2024

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Directions to “CENTERWELL CERTIFIED HEALTHCARE CORP. ” Practice Location

Language	Start Address	Practice Location

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