Provider Demographics
NPI:1174240493
Name:SANKOFA EDUCATIONAL LEADERSHIP UNITED COMPANY
Entity type:Organization
Organization Name:SANKOFA EDUCATIONAL LEADERSHIP UNITED COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JALATEEFA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOE-MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:APSW, AODA
Authorized Official - Phone:608-618-9977
Mailing Address - Street 1:1026 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2040
Mailing Address - Country:US
Mailing Address - Phone:608-618-9977
Mailing Address - Fax:
Practice Address - Street 1:1026 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-2040
Practice Address - Country:US
Practice Address - Phone:608-618-9977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1-7986104916OtherERA
WI18233968852OtherCLAIMS