Healthcare Provider Details

I. General information

NPI: 1700287596
Provider Name (Legal Business Name): KUUMBA HEALTH AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 MELROSE AVE NW
ROANOKE VA
24017-2716
US

IV. Provider business mailing address

3716 MELROSE AVE NW
ROANOKE VA
24017-2716
US

V. Phone/Fax

Practice location:
  • Phone: 540-362-0360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EILEEN LEPRO
Title or Position: CEO
Credential:
Phone: 540-362-0360