Provider Demographics
NPI:1952774358
Name:KUUMBA COMMUNITY HEALTH AND WELLNESS CENTER INC
Entity Type:Organization
Organization Name:KUUMBA COMMUNITY HEALTH AND WELLNESS CENTER INC
Other - Org Name:NEW HORIZONS HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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:540-861-1260
Mailing Address - Street 1:1215 3RD ST SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4611
Mailing Address - Country:US
Mailing Address - Phone:540-857-9700
Mailing Address - Fax:540-857-9709
Practice Address - Street 1:1215 3RD ST SW
Practice Address - Street 2:SUITE A
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4611
Practice Address - Country:US
Practice Address - Phone:540-857-9700
Practice Address - Fax:540-857-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)