Healthcare Provider Details

I. General information

NPI: 1952774358
Provider Name (Legal Business Name): KUUMBA COMMUNITY HEALTH AND WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 3RD ST SW SUITE A
ROANOKE VA
24016-4611
US

IV. Provider business mailing address

1215 3RD ST SW SUITE A
ROANOKE VA
24016-4611
US

V. Phone/Fax

Practice location:
  • Phone: 540-857-9700
  • Fax: 540-857-9709
Mailing address:
  • Phone: 540-857-9700
  • Fax: 540-857-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN STEWART
Title or Position: CEO
Credential:
Phone: 540-861-1260