1003527854 NPI number — SANKOFA MENTAL HEALTH LLC

Table of content: (NPI 1003527854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003527854 NPI number — SANKOFA MENTAL HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANKOFA MENTAL HEALTH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003527854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1925 WESTRIDGE AVE W # A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98466-1877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-348-3536
Provider Business Mailing Address Fax Number:
253-954-1890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1925 WESTRIDGE AVE W # A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-1877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-348-3536
Provider Business Practice Location Address Fax Number:
253-954-1890
Provider Enumeration Date:
12/12/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MAJORS
Authorized Official First Name:
MARLA
Authorized Official Middle Name:
V
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
253-348-3536

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1538722640 . This is a "NA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com