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
1	251J00000X	Nursing Care Agency
2	252Y00000X	Early Intervention Provider Agency
3	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000054236	OTHER	G2
2	15324	OTHER	G2
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7405017	OTHER	G2
5	112135	OTHER	G2
6	ANC015	OTHER	G2
7	000028220	OTHER	G2
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	60800-62	OTHER	G2
10	9894	OTHER	G2
11	120243	OTHER	G2
12	187124	OTHER	G2
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	109673	OTHER	G2
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	94420	OTHER	G2

General Provider Information

NPI Number	:	1518990258
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	:	540 NOEL AVE
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-1386
Country	:	US
Telephone Number	:	270-885-7887
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED SIGNATORY
Name	:	JOHN NICHOLS
Credential	:
Telephone Number	:	270-885-7887

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	11/08/2023

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