Provider Demographics
NPI:1194855155
Name:COUNTY OF KENT
Entity Type:Organization
Organization Name:COUNTY OF KENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-632-7244
Mailing Address - Street 1:700 FULLER AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1918
Mailing Address - Country:US
Mailing Address - Phone:616-632-7120
Mailing Address - Fax:616-632-7083
Practice Address - Street 1:700 FULLER AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1918
Practice Address - Country:US
Practice Address - Phone:616-632-7120
Practice Address - Fax:616-632-7083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X, 261QD0000X
MI2901020199261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1845806Medicaid
MI4529013Medicaid
MI2674614Medicaid