Provider Demographics
NPI:1275329393
Name:OAYE LUTA OKOLAKICIYE
Entity type:Organization
Organization Name:OAYE LUTA OKOLAKICIYE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-391-6470
Mailing Address - Street 1:PO BOX 2792
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-2792
Mailing Address - Country:US
Mailing Address - Phone:605-716-0310
Mailing Address - Fax:
Practice Address - Street 1:937 E NORTH ST STE 401
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1745
Practice Address - Country:US
Practice Address - Phone:605-716-0310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty