Provider Demographics
NPI:1972046522
Name:INNERCORE MANAGEMENT GROUP
Entity Type:Organization
Organization Name:INNERCORE MANAGEMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENDRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:EBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-955-9527
Mailing Address - Street 1:637 SAINT FERDINAND ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-6152
Mailing Address - Country:US
Mailing Address - Phone:225-627-3470
Mailing Address - Fax:
Practice Address - Street 1:637 SAINT FERDINAND ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-6152
Practice Address - Country:US
Practice Address - Phone:225-955-9527
Practice Address - Fax:225-240-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty