NPIMap

Organization Active NPI

Kuumba Community Health & Wellness Center, Inc.

Doing business as New Horizons Healthcare, Valley View

  • Federally Qualified Health Center (FQHC)
  • Roanoke, VA
National Provider Identifier
1821760265
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, Valley View
Practice address
5060 Valley View Blvd NW
Roanoke, VA 24012-2038
Phone
(540) 362-0360
NPI assigned
Oct 4, 2021
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
Jonathan Stewart
Title
Authorized Official
Phone
(540) 861-1260

Specialties & licenses 1

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

Addresses

Primary practice location

5060 Valley View Blvd NW
Roanoke, VA 24012-2038

Mailing address

5060 Valley View Blvd NW
Roanoke, VA 24012-2038

Other names 1

  • New Horizons Healthcare, Valley View Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

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
This NPI is an additional NPI on the enrollment
Practice locations: Roanoke, VA
O20211220002125 VA Part A Provider - Federally Qualified Health Center (FQHC) 1052308632 Practice locations: Roanoke, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821760265. Details of each certification follow.

Federally qualified health center certification: CCN 491984

Legal name
KUUMBA COMMUNITY HEALTH & WELLNESS CENTER, INC
Doing business as
NHHC VALLEY VIEW BLVD MEDICAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 20, 2021
Last certification
Dec 20, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 2, 2021 in VA
Enrollment address
5060 Valley View Blvd NW
Roanoke, VA 24012-2038

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
Tax ID family
Kuumba Community Health Wellness Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1215 3rd St SW
Ste A
Roanoke, VA 24016
Phone (540) 857-9700

4910 Valley View Blvd NW
Ste 310
Roanoke, VA 24012
Phone (540) 362-0360

Ownership & related parties

All disclosed owners & managing parties 16

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 Officer Jan 1, 2020
Correy Austin Diviney Individual Corporate Officer Jan 1, 2020
Corinne Bostic Individual Corporate Director Apr 7, 2024
W-2 Managing Employee Apr 7, 2024
Kimberly Slaughter Individual Corporate Director May 5, 2014
W-2 Managing Employee May 5, 2014
Dianna Hackley-Hunt Individual Corporate Officer Jan 1, 2020
Jonathan Stewart Individual Corporate OfficerCeo Apr 18, 2022
W-2 Managing EmployeeCeo Apr 18, 2022
Angela Hodges Individual Corporate Director Apr 17, 2022
W-2 Managing Employee Apr 17, 2022
Stephanie Michael Individual Corporate Officer Jan 1, 2019
William Lee Individual Corporate Officer Jan 1, 2019
Melanie Frazier Ham Individual Corporate Officer Jan 1, 2019
Kimberly McNeil Individual Corporate Officer Jan 1, 2020
Darlene Bannister Individual Corporate Officer Jan 1, 2018
Maria Conley Individual Corporate Officer Jan 1, 2019
Robert Moore Individual Corporate DirectorCfo Aug 1, 2019
W-2 Managing EmployeeCfo Aug 1, 2019
Belinda English Individual Corporate Officer Jan 1, 2020
Sherman Stovall Individual Corporate Officer Jan 1, 2019

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1633305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698019200000",
    "number": "1821760265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5060 VALLEY VIEW BLVD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240122038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5060 VALLEY VIEW BLVD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240122038",
            "telephone_number": "540-362-0360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KUUMBA COMMUNITY HEALTH & WELLNESS CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-04",
        "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": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "540-861-1260"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Horizons Healthcare, Valley View",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "New Horizons Healthcare, Valley View",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.