Healthcare Provider Details

I. General information

NPI: 1790057149
Provider Name (Legal Business Name): CENIKOR FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E ACADEMY SUITE A
JENNINGS LA
70546
US

IV. Provider business mailing address

PO BOX 4785 MSC 675
HOUSTON TX
77210
US

V. Phone/Fax

Practice location:
  • Phone: 337-824-4705
  • Fax: 337-824-4827
Mailing address:
  • Phone: 713-266-9944
  • Fax: 713-574-2940

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 Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number197
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number481-A
License Number StateLA

VIII. Authorized Official

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