Healthcare Provider Details

I. General information

NPI: 1790610012
Provider Name (Legal Business Name): COMMUNITY CULTURE HEALTH WELLNESS ADVOCACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 HARTFORD AVE
BELLINGHAM MA
02019-3007
US

IV. Provider business mailing address

89 ACCESS RD STE 12
NORWOOD MA
02062-5233
US

V. Phone/Fax

Practice location:
  • Phone: 978-254-4943
  • Fax:
Mailing address:
  • Phone: 978-254-4943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KUDAKWASHE ALLAN MUDARIKWA
Title or Position: HEALTHCARE ADMINISTRATOR
Credential:
Phone: 978-254-4943