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General NPI Number Information
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NPI Number | 1750077848
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Entity Type | Organization
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Legal Business Name | BARIKUURA VITALITY BEHAVIORAL HOME LLC
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 12638 W SUPERIOR AVE
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City | AVONDALE
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State | AZ
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Zip | 85323-9631
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Country | US
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Telephone | 623-932-9425
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Fax |
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Provider Business Mailing Address
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Address Line | 12638 W SUPERIOR AVE
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City | AVONDALE
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State | AZ
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Zip | 85323-9631
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Country | US
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Telephone | 623-932-9425
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Fax |
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Authorized Official
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Title or Position | THE ADMINISTRATOR
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Name | LETOR KPEE
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Credential | BACHELOR IN ENGLISH
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Telephone | 623-570-1308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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