Healthcare Provider Details

I. General information

NPI: 1104897198
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: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 BROADWAY AVE
YOUNGSTOWN OH
44504-1752
US

IV. Provider business mailing address

284 BROADWAY AVE
YOUNGSTOWN OH
44504-1752
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0305
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number0305
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number04-2038
License Number StateOH

VIII. Authorized Official

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