Active NPI
Tia Nicole Henderson
- Home Health Aide
- Massillon, OH
National Provider Identifier
1508505330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- Practice address
- 309 1St St SW
Massillon, OH 44646-6723 - Phone
- (330) 327-9128
- NPI assigned
- May 31, 2022
- Reactivated
- Jul 25, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | Primary |
Addresses
Primary practice location
309 1St St SW
Massillon, OH 44646-6723
Mailing address
309 1St St SW
Massillon, OH 44646-6723
Phone (330) 327-9128
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7611294 | Medicaid | OH |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Starrangel | Single Specialty | Current | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690588800000",
"number": "1508505330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "309 1ST ST SW",
"city": "MASSILLON",
"state": "OH",
"postal_code": "446466723",
"telephone_number": "330-327-9128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 1ST ST SW",
"city": "MASSILLON",
"state": "OH",
"postal_code": "446466723",
"telephone_number": "330-327-9128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "TIA",
"middle_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-31",
"last_updated": "2023-07-29",
"certification_date": "2023-07-29",
"deactivation_date": "2023-07-06",
"reactivation_date": "2023-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Home Health Aide",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7611294",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Massillon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.