Healthcare Provider Details

I. General information

NPI: 1770338758
Provider Name (Legal Business Name): OBAKAYE TEMPLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5070 VEGAS VALLEY DR UNIT 621804
LAS VEGAS NV
89162-8882
US

IV. Provider business mailing address

5070 VEGAS VALLEY DR UNIT 621804
LAS VEGAS NV
89162-8882
US

V. Phone/Fax

Practice location:
  • Phone: 702-371-3823
  • Fax:
Mailing address:
  • Phone: 702-371-3823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

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