Provider Demographics
NPI:1447530134
Name:CENIKOR FOUNDATION
Entity type:Organization
Organization Name:CENIKOR FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-266-9944
Mailing Address - Street 1:PO BOX 4785
Mailing Address - Street 2:MSC 675
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210
Mailing Address - Country:US
Mailing Address - Phone:713-266-9944
Mailing Address - Fax:713-574-2940
Practice Address - Street 1:4012 AVENUE H
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70615-5186
Practice Address - Country:US
Practice Address - Phone:337-491-2355
Practice Address - Fax:337-491-2492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENIKOR FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-25
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0405X
LA481324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility