Provider Demographics
NPI:1750077848
Name:BARIKUURA VITALITY BEHAVIORAL HOME LLC
Entity type:Organization
Organization Name:BARIKUURA VITALITY BEHAVIORAL HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LETOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KPEE
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELOR IN ENGLISH
Authorized Official - Phone:623-570-1308
Mailing Address - Street 1:12638 W SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-9631
Mailing Address - Country:US
Mailing Address - Phone:623-932-9425
Mailing Address - Fax:
Practice Address - Street 1:12638 W SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-9631
Practice Address - Country:US
Practice Address - Phone:623-932-9425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility