MEDICARE: SANKOFA INITIATIVE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		NC

General Provider Information

NPI Number	:	1366770430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANKOFA INITIATIVE LLC

Provider Business Mailing Address
First Line	:	1003 LAMOND AVE
Second Line	:	SUITE B
City	:	DURHAM
State	:	NC
Zip	:	27701-2020
Country	:	US
Telephone Number	:	919-423-2362
Fax Number	:	919-237-3435

Provider Business Practice Location Address
First Line	:	1003 LAMOND AVE
Second Line	:	SUITE B
City	:	DURHAM
State	:	NC
Zip	:	27701-2020
Country	:	US
Telephone Number	:	919-423-2362
Fax Number	:	919-237-3435

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. ALAN SPRUYT
Credential	:	MSPH
Telephone Number	:	919-423-2362

Provider Enumeration Date	:	11/30/2009
Last Update Date	:	11/30/2009

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Directions to “SANKOFA INITIATIVE LLC ” Practice Location

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