Provider Demographics
NPI:1568245983
Name:BSHARA, MARK (THE GODS CARE AGENCY)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BSHARA
Suffix:
Gender:M
Credentials:THE GODS CARE AGENCY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46290 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5608
Mailing Address - Country:US
Mailing Address - Phone:770-773-0008
Mailing Address - Fax:
Practice Address - Street 1:46290 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-5608
Practice Address - Country:US
Practice Address - Phone:770-773-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1306431184Medicaid