Active NPI
Mariners Inn
- Substance Abuse Rehabilitation Facility
- Detroit, MI
National Provider Identifier
1184835084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Substance Abuse Rehabilitation Facility
- License
- 820152
- Legal business name
- MARINERS INN
- Practice address
- 14108 Mark Twain St
445 Ledyard
Detroit, MI 48227-2835 - Phone
- (313) 962-9446
- Fax
- (313) 962-6395
- NPI assigned
- May 24, 2007
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. David Sampson, MSW
- Title
- Deputy Director
- Phone
- (313) 962-9446
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | 820152 | MI | Primary |
Addresses
Primary practice location
14108 Mark Twain St
445 Ledyard
Detroit, MI 48227-2835
Mailing address
445 Ledyard St
Detroit, MI 48201-2641
Phone (313) 962-9446
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 820152 | Other | MI | SUBSTANCE ABUSE |
National Provider Directory
National Provider Directory- Tax ID family
- Mariners Inn
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Peer Specialist
- Detroit, MI
- NPI 1528982261
-
- Mental Illness Community Based Residential Treatment Facility
- Detroit, MI
- NPI 1558485466
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Clinical Social Worker
- Detroit, MI
- NPI 1841416153
-
- Community Health Worker
- Detroit, MI
- NPI 1851919674
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1184835084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "445 LEDYARD ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012641",
"telephone_number": "313-962-9446",
"fax_number": "313-962-6395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14108 MARK TWAIN ST",
"address_2": "445 LEDYARD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482272835",
"telephone_number": "313-962-9446",
"fax_number": "313-962-6395"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARINERS INN",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-24",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "SAMPSON",
"authorized_official_first_name": "DAVID",
"authorized_official_title_or_position": "DEPUTY DIRECTOR",
"authorized_official_telephone_number": "313-962-9446",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "MSW"
},
"taxonomies": [
{
"code": "324500000X",
"taxonomy_group": "",
"desc": "Substance Abuse Rehabilitation Facility",
"state": "MI",
"license": "820152",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUBSTANCE ABUSE",
"identifier": "820152",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.