Provider Demographics
NPI:1366770430
Name:SANKOFA INITIATIVE LLC
Entity type:Organization
Organization Name:SANKOFA INITIATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRUYT
Authorized Official - Suffix:
Authorized Official - Credentials:MSPH
Authorized Official - Phone:919-423-2362
Mailing Address - Street 1:1003 LAMOND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2020
Mailing Address - Country:US
Mailing Address - Phone:919-423-2362
Mailing Address - Fax:919-237-3435
Practice Address - Street 1:1003 LAMOND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2020
Practice Address - Country:US
Practice Address - Phone:919-423-2362
Practice Address - Fax:919-237-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health