Provider Demographics
NPI:1033108832
Name:TRIANGLE INDUSTRIES INC
Entity Type:Organization
Organization Name:TRIANGLE INDUSTRIES INC
Other - Org Name:CIRCLE OF LIFE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-245-0625
Mailing Address - Street 1:15000 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1973
Mailing Address - Country:US
Mailing Address - Phone:313-245-0600
Mailing Address - Fax:313-372-8657
Practice Address - Street 1:15000 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1973
Practice Address - Country:US
Practice Address - Phone:313-245-0600
Practice Address - Fax:313-372-8657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIH-11/2004 (2)283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-4038Medicare ID - Type Unspecified