Provider Demographics
NPI:1619254711
Name:CERTIFY AGENCY RESOURCES ENFORCEMENT, LLC, IN LOUISIANA
Entity Type:Organization
Organization Name:CERTIFY AGENCY RESOURCES ENFORCEMENT, LLC, IN LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:JULIET
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-478-1889
Mailing Address - Street 1:1818 ALVAR ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-5131
Mailing Address - Country:US
Mailing Address - Phone:614-800-9748
Mailing Address - Fax:
Practice Address - Street 1:2600 HINGHAM LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-3725
Practice Address - Country:US
Practice Address - Phone:614-478-1889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CERTIFY AGENCY RESOURCES ENFORCEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-03
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251S00000X, 261QM0850X
OHRL136860347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No347C00000XTransportation ServicesPrivate Vehicle