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Organization
CERTICARE, INC.
Active
Organization
CERTICARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL D DOUGLAS SR. (PRESIDENT/CEO)
(318) 255-1077
Entity
Organization
Contact information
Practice address
3018 OLD MINDEN RD, 1110, BOSSIER CITY, LA 71112-2446
(318) 742-4510
(318) 742-4096
Mailing address
107 WEST ALABAMA AVE, RUSTON, LA 71270
(318) 255-1077
(318) 254-8250
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1784613
—
LA
Enumeration date
01/11/2008
Last updated
02/06/2008
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