Healthcare Provider Details

I. General information

NPI: 1326805292
Provider Name (Legal Business Name): CHARLES HINES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 MADISON RD
CINCINNATI OH
45227-1491
US

IV. Provider business mailing address

2300 SAINT JAMES AVE APT 2
CINCINNATI OH
45206-2900
US

V. Phone/Fax

Practice location:
  • Phone: 513-272-2800
  • Fax:
Mailing address:
  • Phone: 251-751-4024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: