MEDICARE: KEISHA HINES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	021998	TX

General Provider Information

NPI Number	:	1073207957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHA HINES

Provider Business Mailing Address
First Line	:	12025 RICHMOND AVE APT 14203
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2498
Country	:	US
Telephone Number	:	281-912-7432
Fax Number	:

Provider Business Practice Location Address
First Line	:	12025 RICHMOND AVE APT 14203
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2498
Country	:	US
Telephone Number	:	281-912-7432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	06/05/2023

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Directions to “ KEISHA HINES ” Practice Location

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