NPIMap

Organization Active NPI

Baraka House LLC

  • Assisted Living Facility (Mental Illness)
  • Phoenix, AZ
National Provider Identifier
1104084383
Registry record updated Apr 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X
License
BH 3059 Issued in AZ
Legal business name
BARAKA HOUSE LLC
Practice address
13619 N 36TH Ave
Phoenix, AZ 85029-1103
Phone
(602) 824-9100
Fax
(602) 249-8900
NPI assigned
May 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Victor Okorie, M.A., PH.D., LPC
Title
Director
Phone
(602) 524-0824

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility (Mental Illness) 3104A0625X BH 3059 AZ Primary

Addresses

Primary practice location

13619 N 36TH Ave
Phoenix, AZ 85029-1103

Mailing address

10000 N 31St Ave Ste A107
Phoenix, AZ 85051-9582
Phone (602) 441-2388

Other identifiers 1

IdentifierTypeStateIssuer
BH 3059OtherAZAZ OBHL

Other names 1

  • Baraka House Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Baraka House LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10000 N 31st Ave
Ste A107
Phoenix, AZ 85051
Phone (602) 441-2388

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649808000000",
    "number": "1104084383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10000 N 31ST AVE STE A107",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850519582",
            "telephone_number": "602-441-2388",
            "fax_number": "800-524-0824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13619 N 36TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850291103",
            "telephone_number": "602-824-9100",
            "fax_number": "602-249-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARAKA HOUSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-24",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-07",
        "status": "A",
        "authorized_official_last_name": "OKORIE",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "602-524-0824",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.A., PH.D., LPC"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "AZ",
            "license": "BH 3059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ OBHL",
            "identifier": "BH 3059",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baraka House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.