Keith Henderson II

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

5845 Issued in CA

Practice address

5115 W Adams Blvd
Los Angeles, CA 90016-2727

Phone

(323) 933-3439

Fax

(323) 933-5973

NPI assigned

Jun 6, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Team One Stop, Inc

  • Voluntary or Charitable Agency
  • Los Angeles, CA
  • NPI 1023228962
  NPD (past)

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215130430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2127 E 99TH PL",
            "address_2": "#193",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900023152",
            "telephone_number": "323-220-9356",
            "fax_number": "323-933-5973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 W ADAMS BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900162727",
            "telephone_number": "323-933-3439",
            "fax_number": "323-933-5973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KEITH",
        "name_suffix": "II",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "CA",
            "license": "5845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAS REGISTRATION",
            "identifier": "5845",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gena Beth Henderson, APRN, WHNP-BC, IBCLC
• Heather Rose Henderson
• Helen Henderson, RDA
• Hillary Henderson, APCC
• Holly Henderson
• Latoya M Henderson
• Lauren Henderson
• Leon Henderson, M.D.
• Nakeyia Louise Henderson
• Odessa Henderson

• Case Manager/Care Coordinator in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Case Manager/Care Coordinator in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.