MEDICARE: FADHILAH MANSOR

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		MI
2	374U00000X	Home Health Aide		MI

General Provider Information

NPI Number	:	1467335091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FADHILAH MANSOR

Provider Business Mailing Address
First Line	:	42259 LOCKLIN DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-2823
Country	:	US
Telephone Number	:	586-201-1319
Fax Number	:

Provider Business Practice Location Address
First Line	:	42259 LOCKLIN DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-2823
Country	:	US
Telephone Number	:	586-201-1319
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2025
Last Update Date	:	07/30/2025

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Directions to “ FADHILAH MANSOR ” Practice Location

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