Healthcare Provider Details

I. General information

NPI: 1528982261
Provider Name (Legal Business Name): MARINERS INN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 LEDYARD ST
DETROIT MI
48201-2641
US

IV. Provider business mailing address

445 LEDYARD ST
DETROIT MI
48201-2641
US

V. Phone/Fax

Practice location:
  • Phone: 313-962-9446
  • Fax: 313-502-5147
Mailing address:
  • Phone: 313-962-9446
  • Fax: 313-502-5147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVID VAUGHN
Title or Position: PEER RECOVERY COACH
Credential:
Phone: 313-962-9446