Provider Demographics
NPI:1164294872
Name:THE HAINES COMPANY OF KEYSER LLC
Entity Type:Organization
Organization Name:THE HAINES COMPANY OF KEYSER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-876-3571
Mailing Address - Street 1:160 EAGLEHURST DR
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-1370
Mailing Address - Country:US
Mailing Address - Phone:301-876-3571
Mailing Address - Fax:
Practice Address - Street 1:90 CARSKADON LN
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2919
Practice Address - Country:US
Practice Address - Phone:304-898-1750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies