NPIMap

Organization Active NPI

Kuumba Community Health & Wellness Center, Inc.

Doing business as New Horizons Healthcare

  • Federally Qualified Health Center (FQHC)
  • Roanoke, VA
National Provider Identifier
1205815420
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KUUMBA COMMUNITY HEALTH & WELLNESS CENTER, INC.
Doing business as
New Horizons Healthcare
Practice address
3716 Melrose Ave NW
Roanoke, VA 24017-2716
Phone
(540) 362-5158
Fax
(540) 362-1448
NPI assigned
Jan 16, 2006
Last updated
Oct 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Jonathan Stewart
Title
Chief Executive Officer
Phone
(540) 861-1263

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

3716 Melrose Ave NW
Roanoke, VA 24017-2716

Mailing address

3716 Melrose Ave NW
Roanoke, VA 24017-2716
Phone (540) 362-5158

Other identifiers 1

IdentifierTypeStateIssuer
007600321MedicaidVA

Other names 1

  • New Horizons Healthcare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040427000330 VA Part B Supplier - Clinic/Group Practice 1052308632 Receives reassigned benefits from 31 practitioners
1 other NPI on this enrollment
Practice locations: Roanoke, VA
O20070130000695 VA Part A Provider - Federally Qualified Health Center (FQHC) 1052308632 Practice locations: Roanoke, VA
O20210218000878 VA MDPP Supplier - in-Person MDPP Supplier 1052308632 Practice locations: Roanoke, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205815420. Details of each certification follow.

Federally qualified health center certification: CCN 491844

Legal name
KUUMBA COMMUNITY HEALTH & WELLNESS CENTER, INC
Doing business as
NEW HORIZONS HEALTHCARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 4, 2000
Last certification
Dec 4, 2000
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 31, 1999 in VA
Enrollment address
3716 Melrose Ave NW
Roanoke, VA 24017-2716

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Linda Manns Individual Corporate Director Jan 22, 2007
Correy Austin Diviney Individual Corporate Director Jan 1, 2020
Chance Welfare Individual Corporate Director Nov 1, 2018
W-2 Managing EmployeeCao Nov 1, 2018
Dianna Hackley-Hunt Individual Corporate Director Jan 1, 2020
Jonathan Stewart Individual Corporate DirectorCeo Apr 18, 2022
Stephanie Michael Individual Corporate Director Aug 1, 2013
William Lee Individual Corporate Director Jan 22, 2007
Melanie Frazier Ham Individual Corporate Director Jan 1, 2019
Kimberly McNeil Individual Corporate Director Jan 1, 2020
Darlene Bannister Individual Corporate Director Jan 22, 2007
Maria Conley Individual Corporate Director Jan 1, 2019
Robert Moore Individual Corporate Director Aug 1, 2019
W-2 Managing EmployeeCfo Aug 1, 2019
Belinda English Individual Corporate Director Jan 1, 2020
Sherman Stovall Individual Corporate Director Sep 1, 2013

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698019200000",
    "number": "1205815420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3716 MELROSE AVE NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240172716",
            "telephone_number": "540-362-5158",
            "fax_number": "540-362-1448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3716 MELROSE AVE NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240172716",
            "telephone_number": "540-362-5158",
            "fax_number": "540-362-1448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KUUMBA COMMUNITY HEALTH & WELLNESS CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-16",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "540-861-1263",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007600321",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Horizons Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "New Horizons Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.