Provider Demographics
NPI:1427281567
Name:CENIKOR FOUNDATION
Entity type:Organization
Organization Name:CENIKOR FOUNDATION
Other - Org Name:
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 1:11931 WICKCHESTER LN STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-4572
Mailing Address - Country:US
Mailing Address - Phone:713-395-3191
Mailing Address - Fax:
Practice Address - Street 1:5501 IH 37
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78408
Practice Address - Country:US
Practice Address - Phone:361-826-5350
Practice Address - Fax:361-883-3402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENIKOR FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-24
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0405X
TX358324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065524302Medicaid