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General NPI Number Information
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NPI Number | 1871099481
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Entity Type | Organization
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Legal Business Name | BAYMARK OF MICHIGAN, INC.
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 5500 DIVISION AVENUE SE
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City | KENTWOOD
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State | MI
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Zip | 49548
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Country | US
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Telephone | 214-379-3300
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Fax | 214-550-2635
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Provider Business Mailing Address
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Address Line | 1720 LAKEPOINTE DR STE 170
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City | LEWISVILLE
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State | TX
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Zip | 75057-6458
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Country | US
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Telephone | 214-379-3300
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Fax | 214-550-2635
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Authorized Official
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Title or Position | VP, RCM
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Name | BOND ANDREWS
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Credential |
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Telephone | 214-379-3379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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