Healthcare Provider Details

I. General information

NPI: 1457322448
Provider Name (Legal Business Name): BURDMAN GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 W MARKET ST
WARREN OH
44485-3069
US

IV. Provider business mailing address

284 BROADWAY AVE
YOUNGSTOWN OH
44504-1752
US

V. Phone/Fax

Practice location:
  • Phone: 330-898-6692
  • Fax:
Mailing address:
  • Phone: 330-743-9275
  • Fax: 330-743-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0605
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number04-1822
License Number StateOH

VIII. Authorized Official

Name: MARK WINGERT
Title or Position: CONTROLLER
Credential:
Phone: 330-743-9275