MEDICARE: SANKOFA GROUP

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	1041C0700X	Clinical Social Worker	22145	MN
2	101YM0800X	Mental Health Counselor	22145	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689005035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANKOFA GROUP

Provider Business Mailing Address
First Line	:	690 CLEVELAND AVE S
Second Line	:	690 S CLEVELAND AVE SUITE 150 ST.PAUL, MN
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-1319
Country	:	US
Telephone Number	:	651-493-2856
Fax Number	:	866-335-3963

Provider Business Practice Location Address
First Line	:	690 CLEVELAND AVE S
Second Line	:	690 CLEVELAND AVE SUITE 200
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-1319
Country	:	US
Telephone Number	:	651-300-9605
Fax Number	:	651-789-8028

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	MR. NATHANIEL W HURSE
Credential	:	LICSW/LADC/SAP
Telephone Number	:	612-203-9809

Provider Enumeration Date	:	12/11/2013
Last Update Date	:	03/24/2017

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Directions to “SANKOFA GROUP ” Practice Location

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