Provider Demographics
NPI:1972178424
Name:BARAKA DDD LLC
Entity Type:Organization
Organization Name:BARAKA DDD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZAHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAGENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-570-1138
Mailing Address - Street 1:5800 W WETHERSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1841
Mailing Address - Country:US
Mailing Address - Phone:623-570-1138
Mailing Address - Fax:
Practice Address - Street 1:5450 E DOLPHIN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2205
Practice Address - Country:US
Practice Address - Phone:623-570-1138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities