Provider Demographics
NPI:1982318267
Name:HANES, TYLER RAY
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:RAY
Last Name:HANES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 STRUTHERS COITSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOWELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44436-8723
Mailing Address - Country:US
Mailing Address - Phone:330-301-4072
Mailing Address - Fax:
Practice Address - Street 1:1176 STRUTHERS COITSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOWELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44436-8723
Practice Address - Country:US
Practice Address - Phone:330-301-4072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
No253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker