Healthcare Provider Details

I. General information

NPI: 1639341258
Provider Name (Legal Business Name): BURDMAN GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 05/30/2008
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: 330-898-6992
  • Fax:
Mailing address:
  • Phone: 330-743-9275
  • Fax: 330-743-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number0305
License Number StateOH

VIII. Authorized Official

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