Healthcare Provider Details

I. General information

NPI: 1255168027
Provider Name (Legal Business Name): BARAKA TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 61ST AVE SW UNIT C
SEATTLE WA
98116-4725
US

IV. Provider business mailing address

4448 31ST AVE S
SEATTLE WA
98108-1516
US

V. Phone/Fax

Practice location:
  • Phone: 206-446-7627
  • Fax:
Mailing address:
  • Phone: 206-446-7627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: HASSAN JANIWADE
Title or Position: OWNER
Credential:
Phone: 206-446-7627