Provider Demographics
NPI:1689005035
Name:SANKOFA GROUP
Entity Type:Organization
Organization Name:SANKOFA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:HURSE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW/LADC/SAP
Authorized Official - Phone:612-203-9809
Mailing Address - Street 1:690 CLEVELAND AVE S
Mailing Address - Street 2:690 S CLEVELAND AVE SUITE 150 ST.PAUL, MN
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1319
Mailing Address - Country:US
Mailing Address - Phone:651-493-2856
Mailing Address - Fax:866-335-3963
Practice Address - Street 1:690 CLEVELAND AVE S
Practice Address - Street 2:690 CLEVELAND AVE SUITE 200
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1319
Practice Address - Country:US
Practice Address - Phone:651-300-9605
Practice Address - Fax:651-789-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22145101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1689005035Medicaid