Provider Demographics
NPI:1265551980
Name:HINES ENTERPRISES, LLC
Entity type:Organization
Organization Name:HINES ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-878-1302
Mailing Address - Street 1:105 N TACOMA AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2631
Mailing Address - Country:US
Mailing Address - Phone:253-878-1302
Mailing Address - Fax:206-675-1043
Practice Address - Street 1:105 N TACOMA AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-2631
Practice Address - Country:US
Practice Address - Phone:253-878-1302
Practice Address - Fax:206-675-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008928225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty