Provider Demographics
NPI:1104897198
Name:BURDMAN GROUP, INC.
Entity type:Organization
Organization Name:BURDMAN GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WINGERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-743-9275
Mailing Address - Street 1:284 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1752
Mailing Address - Country:US
Mailing Address - Phone:330-743-9275
Mailing Address - Fax:330-743-6110
Practice Address - Street 1:284 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1752
Practice Address - Country:US
Practice Address - Phone:330-743-9275
Practice Address - Fax:330-743-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0305251B00000X, 251V00000X
OH04-2038320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251V00000XAgenciesVoluntary or Charitable
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02891Medicaid
OH2511357Medicaid