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Organization

CENTERWELL CERTIFIED HEALTHCARE CORP

Active
Other names
CenterWell Home Health
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN NICHOLS (AUTHORIZED SIGNATORY)
(707) 545-7114
Entity
Organization

Contact information

Practice address
5341 OLD REDWOOD HWY STE 350, PETALUMA, CA 94954-7127
(707) 545-7114
Mailing address
6330 SPRINT PKWY STE 300, OVERLAND PARK, KS 66211-1157

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
010000084
CA-COMMERCIAL NUMBER
01
013100P
CA-COMMERCIAL NUMBER
01
05-7036
CA-COMMERCIAL NUMBER
01
057036
CA-COMMERCIAL NUMBER
01
106825024
CA-COMMERCIAL NUMBER
01
11-3414024
CA-COMMERCIAL NUMBER
01
113414024
CA-COMMERCIAL NUMBER
05
333724
CA
01
520121
CA-COMMERCIAL NUMBER
01
564478
CA-COMMERCIAL NUMBER
01
565800
CA-COMMERCIAL NUMBER
01
5868461
CA-COMMERCIAL NUMBER
01
GA0699
CA-COMMERCIAL NUMBER
05
ZZR07036H
CA
01
ZZZ34072Z
CA-BLUE SHIELD
Enumeration date
06/27/2006
Last updated
10/26/2023
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