Healthcare Provider Details

I. General information

NPI: 1790870574
Provider Name (Legal Business Name): YOUTH OASIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/02/2025
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S ACADIAN THRUWAY
BATON ROUGE LA
70806-5019
US

IV. Provider business mailing address

260 S ACADIAN THRUWAY
BATON ROUGE LA
70806-5019
US

V. Phone/Fax

Practice location:
  • Phone: 225-343-6300
  • Fax:
Mailing address:
  • Phone: 225-343-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: TEKOAH BOATNER
Title or Position: CEO
Credential: HS-BCP
Phone: 225-343-6300