Provider Demographics
NPI:1578805693
Name:SANKOFA PROVIDERS
Entity Type:Organization
Organization Name:SANKOFA PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EBONI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:FEEMSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-217-7257
Mailing Address - Street 1:2470 WRONDEL WAY
Mailing Address - Street 2:UNIT 232
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3701
Mailing Address - Country:US
Mailing Address - Phone:775-217-7257
Mailing Address - Fax:775-336-2813
Practice Address - Street 1:2470 WRONDEL WAY
Practice Address - Street 2:UNIT 232
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3701
Practice Address - Country:US
Practice Address - Phone:775-217-7257
Practice Address - Fax:775-336-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health