Healthcare Provider Details

I. General information

NPI: 1336484120
Provider Name (Legal Business Name): ALTUM HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 BRANNON DR
VIRGINIA BEACH VA
23456-6908
US

IV. Provider business mailing address

2509 GEORGE MASON DR SUITE 6973
VIRGINIA BEACH VA
23456-1772
US

V. Phone/Fax

Practice location:
  • Phone: 757-404-6078
  • Fax: 757-282-2696
Mailing address:
  • Phone: 757-404-6078
  • Fax: 757-282-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0001151757
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARSHA DAMARIS KENTISH
Title or Position: CEO/ CASE MANAGER
Credential: RN
Phone: 757-404-6078