Provider Demographics
NPI:1871099481
Name:BAYMARK OF MICHIGAN, INC.
Entity type:Organization
Organization Name:BAYMARK OF MICHIGAN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, RCM
Authorized Official - Prefix:
Authorized Official - First Name:BOND
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-379-3379
Mailing Address - Street 1:1720 LAKEPOINTE DR STE 170
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6458
Mailing Address - Country:US
Mailing Address - Phone:214-379-3300
Mailing Address - Fax:214-550-2635
Practice Address - Street 1:5500 DIVISION AVENUE SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49548
Practice Address - Country:US
Practice Address - Phone:214-379-3300
Practice Address - Fax:214-550-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF18038936OtherCERT OF OCCUPANCY