MEDICARE: SANKOFA WEST COUNSELING CENTER

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	NV20151486602	NV

General Provider Information

NPI Number	:	1487020285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANKOFA WEST COUNSELING CENTER

Provider Business Mailing Address
First Line	:	1191 WARM CANYON WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-3603
Country	:	US
Telephone Number	:	702-622-6516
Fax Number	:	702-586-7530

Provider Business Practice Location Address
First Line	:	826 E CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-1512
Country	:	US
Telephone Number	:	702-622-6516
Fax Number	:	702-586-7530

Authorized Official
Title or Position	:	CEO
Name	:	MR. LESHAWUN RASHAAD PORTER SR.
Credential	:
Telephone Number	:	702-622-6516

Provider Enumeration Date	:	08/15/2015
Last Update Date	:	08/15/2015

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