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NPI Code Detail

MEDICARE: BURDMAN GROUP, INC.

MEDICARE: BURDMAN GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency0605OH
2320800000XMental Illness Community Based Residential Treatment Facility04-1822OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457322448
Entity Type Code : Organization
Provider Name (Legal Business Name) : BURDMAN GROUP, INC.
Provider Business Mailing Address
First Line : 284 BROADWAY AVE
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44504-1752
Country : US
Telephone Number : 330-743-9275
Fax Number : 330-743-6110
Provider Business Practice Location Address
First Line : 3120 W MARKET ST
Second Line :
City : WARREN
State : OH
Zip : 44485-3069
Country : US
Telephone Number : 330-898-6692
Fax Number :
Authorized Official
Title or Position : CONTROLLER
Name : MARK WINGERT
Credential :
Telephone Number : 330-743-9275
Provider Enumeration Date : 01/30/2006
Last Update Date : 11/01/2007

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