Healthcare Provider Details

I. General information

NPI: 1740545284
Provider Name (Legal Business Name): HINES GOOD SAMARITAN HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 MANCHESTER ST.
WINSTON-SALEM NC
27105
US

IV. Provider business mailing address

2219 MANCHESTER ST
WINSTON SALEM NC
27105-5535
US

V. Phone/Fax

Practice location:
  • Phone: 336-995-4563
  • Fax: 336-607-4737
Mailing address:
  • Phone:
  • Fax: 336-607-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. MARGARETTA LOUISE HINES
Title or Position: ADMINISTRATOR
Credential:
Phone: 336-995-4563