# CERTICARE, INC

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

## Provider details

- **NPI number:** 1962697375
- **Authorized official:** MICHAEL DOUGLAS SR. (PRESIDENT/CEO)
- **Authorized official phone:** (318) 255-1077

## Contact information

- **Practice address:** 413 S FARMERVILLE ST, RUSTON, LA 71270-4654
- **Practice address phone:** (318) 255-1077
- **Practice address fax:** (318) 254-8250
- **Mailing address:** 413 S FARMERVILLE ST, RUSTON, LA 71270-4654
- **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 | — | LA | Yes |

## Other

- **Enumeration date:** 09/10/2007
- **Last updated:** 09/10/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1123609 | — | LA |