Provider Demographics
NPI:1003374729
Name:DAVIS, SHARRON GENEVA (HOME CARE PROVIDER)
Entity Type:Individual
Prefix:
First Name:SHARRON
Middle Name:GENEVA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:SHARRON
Other - Middle Name:GENEVA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HOME CARE PROVIDER
Mailing Address - Street 1:440 CHERRY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-5260
Mailing Address - Country:US
Mailing Address - Phone:734-828-9153
Mailing Address - Fax:
Practice Address - Street 1:440 CHERRY GROVE RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-5260
Practice Address - Country:US
Practice Address - Phone:734-828-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI802039433251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI802039433OtherIDENTIFICATION NUMBER
MI802039433OtherHOME CARE PROVIDER