Healthcare Provider Details

I. General information

NPI: 1083132450
Provider Name (Legal Business Name): KUUMBA COMMUNITY HEALTH & WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 MELROSE AVE NW SUITE 130
ROANOKE VA
24017
US

IV. Provider business mailing address

3716 MELROSE AVE NW SUITE 130
ROANOKE VA
24017
US

V. Phone/Fax

Practice location:
  • Phone: 540-283-2552
  • Fax: 540-283-2544
Mailing address:
  • Phone: 540-283-2552
  • Fax: 540-283-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number0201004488
License Number StateVA

VIII. Authorized Official

Name: MRS. KIMBERLEY ALDERMAN SLAUGHTER
Title or Position: PHARMACY DIRECTOR
Credential: RPH, MBA
Phone: 540-283-2555