Provider Demographics
NPI:1346394228
Name:CHARLES HINES & SON, INC
Entity Type:Organization
Organization Name:CHARLES HINES & SON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:HINES
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:336-896-0950
Mailing Address - Street 1:710 COLISEUM DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5362
Mailing Address - Country:US
Mailing Address - Phone:336-896-0950
Mailing Address - Fax:336-896-0955
Practice Address - Street 1:710 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5354
Practice Address - Country:US
Practice Address - Phone:336-896-0950
Practice Address - Fax:336-896-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408751Medicaid