Provider Demographics
NPI:1386278877
Name:EAZ-BARAKEH
Entity type:Organization
Organization Name:EAZ-BARAKEH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:GABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-241-9299
Mailing Address - Street 1:3925 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1305
Mailing Address - Country:US
Mailing Address - Phone:520-887-0265
Mailing Address - Fax:520-303-3454
Practice Address - Street 1:3925 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1305
Practice Address - Country:US
Practice Address - Phone:520-887-0265
Practice Address - Fax:520-303-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL-11385HOtherASSISTED LIVING HOME