# MADISON COMMUNITY HOSPITAL INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** THE BEHAVIORAL CENTER OF MICHIGAN HOSPITAL PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790962157
- **Authorized official:** RYAN GUNABALAN (EXECT ADMIN)
- **Authorized official phone:** (586) 261-2266

## Contact information

- **Practice address:** 4050 E 12 MILE RD, WARREN, MI 48092-2534
- **Practice address phone:** (586) 261-2266
- **Practice address fax:** (586) 582-9570
- **Mailing address:** 4050 E 12 MILE RD, WARREN, MI 48092-2534
- **Mailing address phone:** (586) 261-2266
- **Mailing address fax:** (586) 582-9570

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336I0012X | Institutional Pharmacy | 5301008786 | MI | Yes |

## Other

- **Enumeration date:** 01/29/2008
- **Last updated:** 07/15/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2043619 | PK | — |