Provider Demographics
NPI:1134449176
Name:SANKOFA HEALTHCARE SERVICES
Entity type:Organization
Organization Name:SANKOFA HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-574-8579
Mailing Address - Street 1:22690 ROUGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-5963
Mailing Address - Country:US
Mailing Address - Phone:313-574-8579
Mailing Address - Fax:
Practice Address - Street 1:22690 ROUGEMONT DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5963
Practice Address - Country:US
Practice Address - Phone:313-574-8579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010119312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty