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NPI Code Detail

MEDICARE: BARAKA HOUSE LLC

MEDICARE: BARAKA HOUSE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility
23104A0630XAssisted Living Facility (Behavioral Disturbances)
33104A0625XAssisted Living Facility (Mental Illness)

General Provider Information

NPI Number : 1487546255
Entity Type Code : Organization
Provider Name (Legal Business Name) : BARAKA HOUSE LLC
Provider Business Mailing Address
First Line : PO BOX 72657
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-1028
Country : US
Telephone Number : 602-441-2388
Fax Number : 800-642-8008
Provider Business Practice Location Address
First Line : 4149 W CARON ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-3230
Country : US
Telephone Number : 602-441-2388
Fax Number : 800-642-8008
Authorized Official
Title or Position : PRESIDENT & CEO
Name : VICTOR OBIDIKE OKORIE
Credential :
Telephone Number : 602-441-2388
Provider Enumeration Date : 07/16/2025
Last Update Date : 07/16/2025

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Directions to “BARAKA HOUSE LLC ” Practice Location

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