Organization
MADISON COMMUNITY HOSPITAL INC
Active
Other names
Samaritan Behavioral Center - Professional Billing
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN GUNABALAN (CEO)
(586) 261-2266
Entity
Organization
Contact information
Practice address
5555 CONNER ST, DETROIT, MI 48213-3448
(313) 344-7730
Mailing address
5555 CONNER ST, DETROIT, MI 48213-3448
(313) 344-7730
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/14/2019
Last updated
05/29/2019
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