Organization
CENTERWELL CERTIFIED HEALTHCARE CORP.
Active
Other names
CenterWell Home Health
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN NICHOLS (AUTHORIZED SIGNATORY)
(209) 474-7881
Entity
Organization
Contact information
Practice address
10100 TRINITY PKWY STE 425, STOCKTON, CA 95219-7238
(209) 474-7881
(209) 474-2958
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
—
013100P
CA-COMMERCIAL NUMBER
—
01
—
030000602
CA-COMMERCIAL NUMBER
—
01
—
05-8025
CA-COMMERCIAL NUMBER
—
01
—
058025
CA-COMMERCIAL NUMBER
—
01
—
106825033
CA-COMMERCIAL NUMBER
—
01
—
113414024
CA-COMMERCIAL NUMBER
—
01
—
114543
CA-COMMERCIAL NUMBER
—
01
—
564478
CA-COMMERCIAL NUMBER
—
01
—
5868461
CA-COMMERCIAL NUMBER
—
01
—
9900542
CA-COMMERCIAL NUMBER
—
01
—
ANC015
CA-COMMERCIAL NUMBER
—
01
—
GA0588
CA-COMMERCIAL NUMBER
—
05
—
HHA08025F
—
CA
01
—
ZZZ57312Z
CA-BLUE SHIELD
—
Enumeration date
07/07/2006
Last updated
10/26/2023
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