Healthcare Provider Details

I. General information

NPI: 1124241955
Provider Name (Legal Business Name): CLINT L HINES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 SHADY ACRES LN
NEWTON TX
75966
US

IV. Provider business mailing address

405 SHADY ACRES LN
NEWTON TX
75966
US

V. Phone/Fax

Practice location:
  • Phone: 409-379-8911
  • Fax: 409-379-2851
Mailing address:
  • Phone: 409-379-8911
  • Fax: 409-379-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number135824
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number676055
License Number StateTX

VIII. Authorized Official

Name: ROSS NATHANIEL HINES
Title or Position: ADMINISTRATOR
Credential:
Phone: 409-379-8911