Healthcare Provider Details

I. General information

NPI: 1376212886
Provider Name (Legal Business Name): KUUMBA COMM HEALTH & WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 VALLEY VIEW BLVD NW
ROANOKE VA
24012-2038
US

IV. Provider business mailing address

3716 MELROSE AVE NW
ROANOKE VA
24017-2716
US

V. Phone/Fax

Practice location:
  • Phone: 540-283-2555
  • Fax: 540-283-2544
Mailing address:
  • Phone: 540-283-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLEY ALDERMAN SLAUGHTER
Title or Position: PHARMACY DIRECTOR
Credential: R.PH.
Phone: 540-283-2555