Provider Demographics
NPI:1487546255
Name:BARAKA HOUSE LLC
Entity type:Organization
Organization Name:BARAKA HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:OBIDIKE
Authorized Official - Last Name:OKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-441-2388
Mailing Address - Street 1:PO BOX 72657
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-1028
Mailing Address - Country:US
Mailing Address - Phone:602-441-2388
Mailing Address - Fax:800-642-8008
Practice Address - Street 1:4149 W CARON ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-3230
Practice Address - Country:US
Practice Address - Phone:602-441-2388
Practice Address - Fax:800-642-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances