Provider Demographics
NPI:1508223785
Name:SANKOFA SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:SANKOFA SUPPORT SERVICES INC
Other - Org Name:GOODWILL SUPPORT SERVICES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PREISDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:B
Authorized Official - Last Name:TUFFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:978-376-5450
Mailing Address - Street 1:463 MERRIMACK ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3945
Mailing Address - Country:US
Mailing Address - Phone:978-376-5450
Mailing Address - Fax:
Practice Address - Street 1:463 MERRIMACK ST
Practice Address - Street 2:SUITE 109
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3945
Practice Address - Country:US
Practice Address - Phone:978-376-5450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA385H00000X385HR2050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp