Healthcare Provider Details

I. General information

NPI: 1326546094
Provider Name (Legal Business Name): CENIKOR FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 11/06/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 BUNKER HILL DR
BATON ROUGE LA
70808-3303
US

IV. Provider business mailing address

PO BOX 4785 MSC 675
HOUSTON TX
77210
US

V. Phone/Fax

Practice location:
  • Phone: 888-236-4567
  • Fax: 713-579-2940
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

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