Organization
CERTICARE,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL DOUGLAS SR. (PRESIDENT)
(318) 255-1077
Entity
Organization
Contact information
Practice address
413 S FARMERVILLE ST, RUSTON, LA 71270-4654
(318) 255-1077
(318) 254-8250
Mailing address
3018 OLD MINDEN RD, BOSSIER CITY, LA 71112-2446
(318) 742-4510
(318) 742-4096
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1773620
—
LA
Enumeration date
07/16/2007
Last updated
08/22/2020
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