Organization
CERTICARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL DOUGLAS SR. (PRESIDENT/CEO)
(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
413 S FARMERVILLE ST, RUSTON, LA 71270-4654
(318) 255-1077
(318) 254-8250
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1123609
—
LA
Enumeration date
09/10/2007
Last updated
09/10/2007
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