MEDICARE: MARK BSHARA THE GODS CARE AGENCY

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	374U00000X	Home Health Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568245983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK BSHARA THE GODS CARE AGENCY

Provider Business Mailing Address
First Line	:	46290 HAMPTON DR
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48315-5608
Country	:	US
Telephone Number	:	770-773-0008
Fax Number	:

Provider Business Practice Location Address
First Line	:	46290 HAMPTON DR
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48315-5608
Country	:	US
Telephone Number	:	770-773-0008
Fax Number	:

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

Provider Enumeration Date	:	08/17/2023
Last Update Date	:	12/18/2023

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