Provider Demographics
NPI:1306197033
Name:SUNKWA AFRICAN ART AND CRAFT
Entity Type:Organization
Organization Name:SUNKWA AFRICAN ART AND CRAFT
Other - Org Name:LIFELINE COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONWILLIAMS
Authorized Official - Middle Name:A
Authorized Official - Last Name:YEBOAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-476-1316
Mailing Address - Street 1:11905 S CENTRAL AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-2897
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11905 S CENTRAL AVE
Practice Address - Street 2:STE. 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-2897
Practice Address - Country:US
Practice Address - Phone:323-476-1316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health