- Enrollment id
- O20021202000027
- Enrollment state
- ME
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1255362943
- Multiple npi flag
- N
- Ccn
- 207038
- Associate id
- 7618884529
- Organization name
- CENTERWELL CERTIFIED HEALTHCARE CORP
- Doing business as name
- CENTERWELL HOME HEALTH
- Incorporation date
- 1983-04-19
- Incorporation state
- DE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 30 ATLANTIC PL
- Address line 2
- STE A30
- City
- SOUTH PORTLAND
- State
- ME
- Zip code
- 041062316