Provider Demographics
NPI:1003277823
Name:KUUMBA HEALTH LLC
Entity Type:Organization
Organization Name:KUUMBA HEALTH LLC
Other - Org Name:SACRED WALKER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/ EXECUTIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TANESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV
Authorized Official - Phone:917-412-0358
Mailing Address - Street 1:146B FERRY ST
Mailing Address - Street 2:SUITE 54
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2195
Mailing Address - Country:US
Mailing Address - Phone:917-412-0358
Mailing Address - Fax:
Practice Address - Street 1:26 E 36TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3364
Practice Address - Country:US
Practice Address - Phone:917-412-0358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KUUMBA HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Multi-Specialty