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NPI Code Detail

MEDICARE: CERTICARE, INC

MEDICARE: CERTICARE, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1841499241
Entity Type Code : Organization
Provider Name (Legal Business Name) : CERTICARE, INC
Provider Business Mailing Address
First Line : 3018 OLD MINDEN RD
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71112-2446
Country : US
Telephone Number : 318-742-4510
Fax Number : 318-742-4096
Provider Business Practice Location Address
First Line : 413 S FARMERVILLE ST
Second Line :
City : RUSTON
State : LA
Zip : 71270-4654
Country : US
Telephone Number : 318-255-1077
Fax Number : 318-254-8250
Authorized Official
Title or Position : PRESIDENT
Name : MICHAEL DOUGLAS SR.
Credential :
Telephone Number : 318-255-1077
Provider Enumeration Date : 07/16/2007
Last Update Date : 08/22/2020

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Directions to “CERTICARE, INC ” Practice Location

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