MEDICARE: OBAKAYE TEMPLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374K00000X	Religious Nonmedical Practitioner
2	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1770338758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OBAKAYE TEMPLE

Provider Business Mailing Address
First Line	:	5070 VEGAS VALLEY DR UNIT 621804
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89162-8882
Country	:	US
Telephone Number	:	702-371-3823
Fax Number	:

Provider Business Practice Location Address
First Line	:	5070 VEGAS VALLEY DR UNIT 621804
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89162-8882
Country	:	US
Telephone Number	:	702-371-3823
Fax Number	:

Authorized Official
Title or Position	:	OLUWO/EXECUTIVE DIRECTOR
Name	:	IFAKOLADE O.D.I. REECE
Credential	:
Telephone Number	:	702-371-3823

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/22/2024

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Directions to “OBAKAYE TEMPLE ” Practice Location

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