Provider Demographics
NPI:1487393930
Name:KUUMBA COMMUNITY HEALTH AND WELLNESS CENTER INC.
Entity type:Organization
Organization Name:KUUMBA COMMUNITY HEALTH AND WELLNESS CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-362-0360
Mailing Address - Street 1:3716 MELROSE AVENUE NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017
Mailing Address - Country:US
Mailing Address - Phone:540-655-4948
Mailing Address - Fax:540-566-4102
Practice Address - Street 1:1502 WILLIAMSON ROAD NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012
Practice Address - Country:US
Practice Address - Phone:540-566-3719
Practice Address - Fax:540-204-4288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KUUMBA COMMUNITY HEALTH AND WELLNESS CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-02
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty