Provider Demographics
NPI:1033283023
Name:T&G COPORATION
Entity Type:Organization
Organization Name:T&G COPORATION
Other - Org Name:THE BEHAVIORAL CENTER OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKLO-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-261-2266
Mailing Address - Street 1:4050 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2594
Mailing Address - Country:US
Mailing Address - Phone:586-261-2266
Mailing Address - Fax:586-261-3628
Practice Address - Street 1:4050 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2594
Practice Address - Country:US
Practice Address - Phone:586-261-2266
Practice Address - Fax:586-261-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIH1122005282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI600100Medicaid
MI234039Medicare ID - Type Unspecified