Provider Demographics
NPI:1780977959
Name:BAKARI BEHAVIORAL HEALTH INC.
Entity type:Organization
Organization Name:BAKARI BEHAVIORAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:319-883-3067
Mailing Address - Street 1:515 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-3317
Mailing Address - Country:US
Mailing Address - Phone:319-883-3067
Mailing Address - Fax:319-883-3069
Practice Address - Street 1:515 BEECH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-3317
Practice Address - Country:US
Practice Address - Phone:319-883-3067
Practice Address - Fax:319-883-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-22
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370601201Medicaid
IA1780977959Medicaid