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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