Healthcare Provider Details

I. General information

NPI: 1427778596
Provider Name (Legal Business Name): ANTONE HINES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 E EMPIRE AVE
BENTON HARBOR MI
49022-2020
US

IV. Provider business mailing address

1440 E EMPIRE AVE
BENTON HARBOR MI
49022-2020
US

V. Phone/Fax

Practice location:
  • Phone: 269-487-9820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: