Healthcare Provider Details

I. General information

NPI: 1548298151
Provider Name (Legal Business Name): CEE-BREEZE SILMHR, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 KILDEER ST
BATON ROUGE LA
70807-3009
US

IV. Provider business mailing address

30 HARBOR COVE DR
THE WOODLANDS TX
77381-3339
US

V. Phone/Fax

Practice location:
  • Phone: 225-775-9997
  • Fax: 225-775-9810
Mailing address:
  • Phone: 832-647-8897
  • Fax: 281-362-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberSIL 11426
License Number StateLA

VIII. Authorized Official

Name: MR. CLARENCE R BAKER SR.
Title or Position: PRESIDENT
Credential:
Phone: 832-647-8897