Provider Demographics
NPI:1861789059
Name:CERTIFY AGENCY RESOURCES ENFORCEMENT
Entity type:Organization
Organization Name:CERTIFY AGENCY RESOURCES ENFORCEMENT
Other - Org Name:<UNAVAIL>
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:614-800-9748
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:614-732-7415
Mailing Address - Fax:614-478-1889
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:614-732-7415
Practice Address - Fax:614-478-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X, 333300000X, 385H00000X
OH253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No333300000XSuppliersEmergency Response System Companies
No385H00000XRespite Care FacilityRespite Care