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General NPI Number Information
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NPI Number | 1730778945
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Entity Type | Organization
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Legal Business Name | SANKOFA LLC
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 1761 E CHAMBERS ST
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City | PHOENIX
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State | AZ
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Zip | 85040-3322
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Country | US
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Telephone | 623-326-0617
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Fax |
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Provider Business Mailing Address
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Address Line | 13720 N 88TH AVE APT 2078
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City | PEORIA
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State | AZ
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Zip | 85381-3812
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAMISIA JONES
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Credential |
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Telephone | 623-326-0617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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