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General NPI Number Information
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NPI Number | 1205815420
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Entity Type | Organization
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Legal Business Name | KUUMBA COMMUNITY HEALTH & WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 01/16/2006
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 3716 MELROSE AVE NW
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City | ROANOKE
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State | VA
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Zip | 24017-2716
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Country | US
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Telephone | 540-362-5158
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Fax | 540-362-1448
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Provider Business Mailing Address
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Address Line | 3716 MELROSE AVE NW
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City | ROANOKE
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State | VA
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Zip | 24017-2716
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Country | US
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Telephone | 540-362-5158
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Fax | 540-362-1448
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. JONATHAN STEWART
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Credential |
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Telephone | 540-861-1263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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