Healthcare Provider Details

I. General information

NPI: 1598656035
Provider Name (Legal Business Name): COMMUNITY WELLNESS HUB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 ORANGE ST
MONROE LA
71202-2325
US

IV. Provider business mailing address

1511 ORANGE ST
MONROE LA
71202-2325
US

V. Phone/Fax

Practice location:
  • Phone: 318-582-0354
  • Fax: 214-889-8499
Mailing address:
  • Phone: 318-582-0354
  • Fax: 214-889-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KALETHIA BUSH
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 318-331-2150