Healthcare Provider Details

I. General information

NPI: 1003200924
Provider Name (Legal Business Name): SANKOFA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 03/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 KEY HWY UNIT 442
BALTIMORE MD
21230-3976
US

IV. Provider business mailing address

801 KEY HWY UNIT 442
BALTIMORE MD
21230-3976
US

V. Phone/Fax

Practice location:
  • Phone: 301-758-3682
  • Fax:
Mailing address:
  • Phone: 301-758-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number17157
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number0896
License Number StateMD

VIII. Authorized Official

Name: TERRY J WHITE
Title or Position: OWNER
Credential:
Phone: 301-758-3682