Basic Information
| Provider Information | |||||||||
| NPI: | 1588672406 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | T & G CORPORATION INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE BEHAVIORAL CENTER OF MICHIGAN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4050 E 12 MILE RD | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480922534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862612266 | ||||||||
| FaxNumber: | 5862613628 | ||||||||
| Practice Location | |||||||||
| Address1: | 4050 E 12 MILE RD | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480922534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862612266 | ||||||||
| FaxNumber: | 5862613628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 01/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | GUNABALAN | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5862612266 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | T & G CORPORATION INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
No ID Information.