MEDICARE: JANNYELL HINES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider	24-016873	IN
2	3747P1801X	Personal Care Attendant	24-016873	IN
3	376J00000X	Homemaker	24-016873	IN

General Provider Information

NPI Number	:	1376396739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANNYELL HINES

Provider Business Mailing Address
First Line	:	3002 BONDS AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-1931
Country	:	US
Telephone Number	:	574-381-0867
Fax Number	:

Provider Business Practice Location Address
First Line	:	3002 BONDS AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-1931
Country	:	US
Telephone Number	:	574-381-0867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	10/06/2024

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Directions to “ JANNYELL HINES ” Practice Location

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