Provider Demographics
NPI:1821670225
Name:ROUSE, SIMONE DENISE (EDS)
Entity Type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:DENISE
Last Name:ROUSE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HELEN DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-3319
Mailing Address - Country:US
Mailing Address - Phone:757-344-8821
Mailing Address - Fax:
Practice Address - Street 1:11 HELEN DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-3319
Practice Address - Country:US
Practice Address - Phone:757-344-8821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-25
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA7420251S00000X
372600000X, 261Q00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Yes251S00000XAgenciesCommunity/Behavioral Health
No372600000XNursing Service Related ProvidersAdult Companion
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center