Healthcare Provider Details

I. General information

NPI: 1053603845
Provider Name (Legal Business Name): LOUISIANA OUTREACH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8211 SUMMA AVE #F
BATON ROUGE LA
70809-3471
US

IV. Provider business mailing address

8211 SUMMA AVE #F
BATON ROUGE LA
70809-3471
US

V. Phone/Fax

Practice location:
  • Phone: 225-636-9102
  • Fax: 866-384-4413
Mailing address:
  • Phone: 225-636-9102
  • Fax: 866-384-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: OSWALD NWOGBO
Title or Position: CEO
Credential:
Phone: 225-636-9102