Organization
MARINERS INN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID SAMPSON LMSW (CHIEF EXECUTIVE OFFICER)
(313) 962-9446
Entity
Organization
Contact information
Practice address
445 LEDYARD ST, DETROIT, MI 48201-2641
(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
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
SA820152
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56421819
TPIN ASSIGNMENT
MI
Enumeration date
03/17/2007
Last updated
04/20/2018
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