Provider Demographics
NPI:1609079235
Name:BARAKA HOUSE
Entity Type:Organization
Organization Name:BARAKA HOUSE
Other - Org Name:BARAKA HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:OKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PHD, LPC
Authorized Official - Phone:602-524-0824
Mailing Address - Street 1:10000 N 31ST AVE STE A107
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9582
Mailing Address - Country:US
Mailing Address - Phone:602-441-2388
Mailing Address - Fax:800-524-0824
Practice Address - Street 1:3740 W CARON ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-3340
Practice Address - Country:US
Practice Address - Phone:602-249-8900
Practice Address - Fax:602-249-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-10
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH27533104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH2753OtherBEHAVIORAL HEALTH LICENSE
AZ114301Medicaid