Provider Demographics
NPI:1538947783
Name:HINES, KE'SHA
Entity type:Individual
Prefix:
First Name:KE'SHA
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PUBLIC SQ APT 1312
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1928
Mailing Address - Country:US
Mailing Address - Phone:216-327-0899
Mailing Address - Fax:
Practice Address - Street 1:25814 FAIRMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-2214
Practice Address - Country:US
Practice Address - Phone:216-409-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide