# CERTICARE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457537169
- **Authorized official:** MR. MICHAEL D DOUGLAS SR. (PRESIDENT/CEO)
- **Authorized official phone:** (318) 255-1077

## Contact information

- **Practice address:** 3018 OLD MINDEN RD, 1110, BOSSIER CITY, LA 71112-2446
- **Practice address phone:** (318) 742-4510
- **Practice address fax:** (318) 742-4096
- **Mailing address:** 107 WEST ALABAMA AVE, RUSTON, LA 71270
- **Mailing address phone:** (318) 255-1077
- **Mailing address fax:** (318) 254-8250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 01/11/2008
- **Last updated:** 02/06/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1784613 | — | LA |