Provider Demographics
NPI:1053603845
Name:LOUISIANA OUTREACH SERVICES
Entity type:Organization
Organization Name:LOUISIANA OUTREACH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OSWALD
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-636-9102
Mailing Address - Street 1:8211 SUMMA AVE
Mailing Address - Street 2:#F
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3471
Mailing Address - Country:US
Mailing Address - Phone:225-636-9102
Mailing Address - Fax:866-384-4413
Practice Address - Street 1:8211 SUMMA AVE
Practice Address - Street 2:#F
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3471
Practice Address - Country:US
Practice Address - Phone:225-636-9102
Practice Address - Fax:866-384-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)