Healthcare Provider Details

I. General information

NPI: 1760152177
Provider Name (Legal Business Name): CERTIFY AGENCY RESOURCES ENFORCEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 HINGHAM LANE
COLUMBUS OH
43224
US

IV. Provider business mailing address

2600 HINGHAM LN
COLUMBUS OH
43224-3725
US

V. Phone/Fax

Practice location:
  • Phone: 614-800-9748
  • Fax: 614-934-5732
Mailing address:
  • Phone: 614-800-9748
  • Fax: 614-934-5732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE JULIET TATE
Title or Position: CEO
Credential: JACQUELINE J TATE
Phone: 614-800-9748