Provider Demographics
NPI:1508580770
Name:OGLALA SIOUX LAKOTA HOUSING
Entity Type:Organization
Organization Name:OGLALA SIOUX LAKOTA HOUSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAR RUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:605-441-5768
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-0603
Mailing Address - Country:US
Mailing Address - Phone:605-867-5161
Mailing Address - Fax:
Practice Address - Street 1:4 SUANNE CENTER DR
Practice Address - Street 2:
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-3272
Practice Address - Country:US
Practice Address - Phone:605-867-5161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty