# MADISON COMMUNITY HOSPITAL INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Samaritan Behavioral Center - Professional Billing
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699234153
- **Authorized official:** RYAN GUNABALAN (CEO)
- **Authorized official phone:** (586) 261-2266

## Contact information

- **Practice address:** 5555 CONNER ST, DETROIT, MI 48213-3448
- **Practice address phone:** (313) 344-7730
- **Mailing address:** 5555 CONNER ST, DETROIT, MI 48213-3448
- **Mailing address phone:** (313) 344-7730

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/14/2019
- **Last updated:** 05/29/2019