Provider Demographics
NPI:1336484120
Name:ALTUM HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:ALTUM HEALTH & WELLNESS, LLC
Other - Org Name:ALTUM SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:DAMARIS
Authorized Official - Last Name:KENTISH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-404-6078
Mailing Address - Street 1:2509 GEORGE MASON DR
Mailing Address - Street 2:SUITE 6973
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1772
Mailing Address - Country:US
Mailing Address - Phone:757-404-6078
Mailing Address - Fax:757-282-2696
Practice Address - Street 1:3600 BRANNON DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-6908
Practice Address - Country:US
Practice Address - Phone:757-404-6078
Practice Address - Fax:757-282-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
VA0001151757251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty