Healthcare Provider Details

I. General information

NPI: 1033108832
Provider Name (Legal Business Name): TRIANGLE INDUSTRIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 GRATIOT AVE
DETROIT MI
48205-1973
US

IV. Provider business mailing address

15000 GRATIOT AVE
DETROIT MI
48205-1973
US

V. Phone/Fax

Practice location:
  • Phone: 313-245-0600
  • Fax: 313-372-8657
Mailing address:
  • Phone: 313-245-0600
  • Fax: 313-372-8657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberH-11/2004 (2)
License Number StateMI

VIII. Authorized Official

Name: MR. CHARLES JOSEPH POWELL
Title or Position: HOSPITAL PRESIDENT
Credential:
Phone: 313-245-0625