MEDICARE: MEISHA RENEE GOODWIN

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

General Provider Information

NPI Number	:	1609697051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEISHA RENEE GOODWIN

Provider Business Mailing Address
First Line	:	4583 E 13 MILE RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48092-1731
Country	:	US
Telephone Number	:	586-441-6779
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 SHELBY ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-3268
Country	:	US
Telephone Number	:	586-441-6779
Fax Number	:

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

Provider Enumeration Date	:	10/18/2024
Last Update Date	:	10/18/2024

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Directions to “ MEISHA RENEE GOODWIN ” Practice Location

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