Healthcare Provider Details

I. General information

NPI: 1881917276
Provider Name (Legal Business Name): CENIKOR FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 11/11/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 BUNKER HILL DRIVE
BATON ROUGE LA
70808
US

IV. Provider business mailing address

PO BOX 4785 MSC 675
HOUSTON TX
77210
US

V. Phone/Fax

Practice location:
  • Phone: 225-218-1960
  • Fax: 225-218-1969
Mailing address:
  • Phone: 713-266-9944
  • Fax: 713-780-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberSA0004174
License Number StateLA

VIII. Authorized Official

Name: MATT KUHLMAN
Title or Position: CEO
Credential:
Phone: 713-266-9944