Provider Demographics
NPI:1790870574
Name:YOUTH OASIS
Entity type:Organization
Organization Name:YOUTH OASIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TEKOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATNER
Authorized Official - Suffix:
Authorized Official - Credentials:HS-BCP
Authorized Official - Phone:225-343-6300
Mailing Address - Street 1:260 S ACADIAN THRUWAY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5019
Mailing Address - Country:US
Mailing Address - Phone:225-343-6300
Mailing Address - Fax:
Practice Address - Street 1:260 S ACADIAN THRUWAY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5019
Practice Address - Country:US
Practice Address - Phone:225-343-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health