Provider Demographics
NPI:1760152177
Name:CERTIFY AGENCY RESOURCES ENFORCEMENT, LLC
Entity Type:Organization
Organization Name:CERTIFY AGENCY RESOURCES ENFORCEMENT, LLC
Other - Org Name:JACQUELINE J TATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:JULIET
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:JACQUELINE J TATE
Authorized Official - Phone:614-800-9748
Mailing Address - Street 1:2600 HINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-3725
Mailing Address - Country:US
Mailing Address - Phone:614-800-9748
Mailing Address - Fax:614-934-5732
Practice Address - Street 1:2600 HINGHAM LANE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224
Practice Address - Country:US
Practice Address - Phone:614-800-9748
Practice Address - Fax:614-934-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053979Medicaid
OH2558101Medicaid
OH0055519Medicaid