Provider Demographics
NPI:1861233538
Name:HINES, CHRISTIAN DENANE
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:DENANE
Last Name:HINES
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 1:4620 FERRIN CV
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-8175
Mailing Address - Country:US
Mailing Address - Phone:901-238-4220
Mailing Address - Fax:
Practice Address - Street 1:4620 FERRIN CV
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-8175
Practice Address - Country:US
Practice Address - Phone:901-238-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home