Individual provider Active NPI

Simone Faith Henderson, COSMETOLOGIST

  • Personal Care Attendant
  • Midlothian, VA
National Provider Identifier
1215572763
Registry record updated Nov 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Personal Care AttendantTaxonomy code 3747P1801X
License
1201134889 Issued in VA
Practice address
11112 Hull Street Rd
Midlothian, VA 23112-3204
Phone
(917) 834-1857
NPI assigned
Nov 7, 2019
Last updated
Nov 7, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 7, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Personal Care Attendant 3747P1801X 22WE1157758 NY
Personal Care Attendant 3747P1801X 1201134889 VA Primary

Addresses

Primary practice location

11112 Hull Street Rd
Midlothian, VA 23112-3204

Mailing address

PO Box 4552
Midlothian, VA 23112-0010
Phone (917) 834-1857

Other practice location 1

15910 Hillside Ave Ste B
Jamaica, NY 11432-3936
Phone (347) 561-9311

Other names 1

  • Simone Faith West Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
22WE1157758NYMDPersonal Care Attendant
1201134889VAMDPersonal Care Attendant

Practice roles

OrganizationSpecialtyStatusNew patients
Hair Art Nyc Inc CurrentSince Nov 5, 2023 Accepting new patients

Locations

11112 Hull Street Rd
Midlothian, VA 23112
Phone (804) 325-9219

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1573084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573084800000",
    "number": "1215572763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4552",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231120010",
            "telephone_number": "917-834-1857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11112 HULL STREET RD",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231123204",
            "telephone_number": "917-834-1857"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15910 Hillside Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Jamaica",
            "state": "NY",
            "postal_code": "114323936",
            "country_code": "US",
            "telephone_number": "347-561-9311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "SIMONE",
        "middle_name": "FAITH",
        "credential": "COSMETOLOGIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-07",
        "last_updated": "2019-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "NY",
            "license": "22WE1157758",
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "VA",
            "license": "1201134889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SIMONE",
            "last_name": "WEST",
            "middle_name": "FAITH",
            "credential": "COSMETOLOGIST",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Midlothian, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2019; 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.