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	0604313	OTHER	G2
2	60-00179	OTHER	G2
3	702022	OTHER	G2
4	63102610611H	OTHER	G2
5	801438	OTHER	G2
6	1020028	OTHER	G2
7	3267811	OTHER	G2
8	0606308/1030200	OTHER	G2
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	0008212	OTHER	G2
11	GA0745	OTHER	G2
12	013100P	OTHER	G2
13	335394	OTHER	G2
14	ANC015	OTHER	G2
15	0606391	OTHER	G2
16	565800	OTHER	G2
17	227260	OTHER	G2

General Provider Information

NPI Number	:	1538190087
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	:	275 MARTINE ST STE 104
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02723-1500
Country	:	US
Telephone Number	:	508-672-0675
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED SIGNATORY
Name	:	JOHN NICHOLS
Credential	:
Telephone Number	:	508-672-0675

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	11/28/2023

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Directions to “CENTERWELL CERTIFIED HEALTHCARE CORP. ” Practice Location

Language	Start Address	Practice Location

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