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General NPI Number Information
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NPI Number | 1922552512
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Entity Type | Organization
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Legal Business Name | KUUMBA COMMUNITY HEALTH & WELLNESS, INC.
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 321 TAZEWELL AVE SE
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City | ROANOKE
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State | VA
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Zip | 24013-1445
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Country | US
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Telephone | 540-362-0360
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Fax | 540-362-1448
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Provider Business Mailing Address
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Address Line | 321 TAZEWELL AVE SE
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City | ROANOKE
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State | VA
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Zip | 24013-1445
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Country | US
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Telephone | 540-362-0360
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Fax | 540-362-1448
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Authorized Official
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Title or Position | CEO
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Name | EILEEN G LEPRO
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Credential | MPH
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Telephone | 540-362-0360
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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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