Organization
BAYMARK OF MICHIGAN, INC.
Active
Organization
BAYMARK OF MICHIGAN, INC.
Active
Other names
MedMark Kentwood
Organization subpart
No
Provider details
NPI number
Authorized official
BOND ANDREWS (VP, RCM)
(214) 379-3379
Entity
Organization
Contact information
Practice address
5500 DIVISION AVENUE SE, KENTWOOD, MI 49548
(214) 379-3300
(214) 550-2635
Mailing address
1720 LAKEPOINTE DR STE 170, LEWISVILLE, TX 75057-6458
(214) 379-3300
(214) 550-2635
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OF18038936
CERT OF OCCUPANCY
MI
Enumeration date
04/03/2018
Last updated
02/20/2019
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