Healthcare Provider Details

I. General information

NPI: 1568245983
Provider Name (Legal Business Name): MARK BSHARA THE GODS CARE AGENCY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 03/01/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46290 HAMPTON DR
SHELBY TOWNSHIP MI
48315-5608
US

IV. Provider business mailing address

46290 HAMPTON DR
SHELBY TOWNSHIP MI
48315-5608
US

V. Phone/Fax

Practice location:
  • Phone: 770-773-0008
  • Fax:
Mailing address:
  • Phone: 770-773-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: