Healthcare Provider Details

I. General information

NPI: 1619254711
Provider Name (Legal Business Name): CERTIFY AGENCY RESOURCES ENFORCEMENT, LLC, IN LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 HINGHAM LN
COLUMBUS OH
43224-3725
US

IV. Provider business mailing address

1818 ALVAR ST
NEW ORLEANS LA
70117-5131
US

V. Phone/Fax

Practice location:
  • Phone: 614-478-1889
  • Fax:
Mailing address:
  • Phone: 614-800-9748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberRL136860
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUELINE JULIET TATE
Title or Position: CEO
Credential:
Phone: 614-478-1889