MEDICARE: MAST VENTURES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1871325134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAST VENTURES, INC

Provider Business Mailing Address
First Line	:	2112 HOMER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1934
Country	:	US
Telephone Number	:	267-496-8922
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 S BROADWAY
Second Line	:
City	:	GLOUCESTER CITY
State	:	NJ
Zip	:	08030-1706
Country	:	US
Telephone Number	:	267-496-8922
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER/DON
Name	:	MUNIRAH AHMAD
Credential	:	RN
Telephone Number	:	267-496-8922

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	09/03/2024

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Directions to “MAST VENTURES, INC ” Practice Location

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