Healthcare Provider Details

I. General information

NPI: 1346394228
Provider Name (Legal Business Name): CHARLES HINES & SON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 COLISEUM DR
WINSTON SALEM NC
27106-5354
US

IV. Provider business mailing address

710 COLISEUM DR STE 100
WINSTON SALEM NC
27106-5362
US

V. Phone/Fax

Practice location:
  • Phone: 336-896-0950
  • Fax: 336-896-0955
Mailing address:
  • Phone: 336-896-0950
  • Fax: 336-896-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES A HINES III
Title or Position: PRESIDENT
Credential:
Phone: 336-896-0950