Provider Demographics
NPI:1942074539
Name:BARAKA SERVICES LLC
Entity Type:Organization
Organization Name:BARAKA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIVUVANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-244-5274
Mailing Address - Street 1:6195 W COUGAR AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6861
Mailing Address - Country:US
Mailing Address - Phone:913-244-5274
Mailing Address - Fax:
Practice Address - Street 1:1125 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4701
Practice Address - Country:US
Practice Address - Phone:913-244-5274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health