Provider Demographics
NPI:1922552512
Name:KUUMBA COMMUNITY HEALTH & WELLNESS, INC.
Entity Type:Organization
Organization Name:KUUMBA COMMUNITY HEALTH & WELLNESS, INC.
Other - Org Name:NEW HORIZONS DENTAL CARE SOUTHEAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEPRO
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:540-362-0360
Mailing Address - Street 1:321 TAZEWELL AVE SE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24013-1445
Mailing Address - Country:US
Mailing Address - Phone:540-362-0360
Mailing Address - Fax:540-362-1448
Practice Address - Street 1:321 TAZEWELL AVE SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-1445
Practice Address - Country:US
Practice Address - Phone:540-362-0360
Practice Address - Fax:540-362-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)