Provider Demographics
NPI:1376212886
Name:KUUMBA COMM HEALTH & WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:KUUMBA COMM HEALTH & WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:ALDERMAN
Authorized Official - Last Name:SLAUGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:540-283-2555
Mailing Address - Street 1:3716 MELROSE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-2716
Mailing Address - Country:US
Mailing Address - Phone:540-283-2555
Mailing Address - Fax:
Practice Address - Street 1:5060 VALLEY VIEW BLVD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-2038
Practice Address - Country:US
Practice Address - Phone:540-283-2555
Practice Address - Fax:540-283-2544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KUUMBA COMM HEALTH & WELLNESS CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy