Organization
MARINERS INN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID SAMPSON MSW (DEPUTY DIRECTOR)
(313) 962-9446
Entity
Organization
Contact information
Practice address
14108 MARK TWAIN ST, 445 LEDYARD, DETROIT, MI 48227-2835
(313) 962-9446
(313) 962-6395
Mailing address
445 LEDYARD ST, DETROIT, MI 48201-2641
(313) 962-9446
(313) 962-6395
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
820152
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
820152
SUBSTANCE ABUSE
MI
Enumeration date
05/24/2007
Last updated
08/22/2020
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