Provider Demographics
NPI:1114754843
Name:BERGAMOT GROUP LLC
Entity type:Organization
Organization Name:BERGAMOT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-317-0865
Mailing Address - Street 1:1260 HUNTINGTON DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4561
Mailing Address - Country:US
Mailing Address - Phone:626-317-0865
Mailing Address - Fax:626-317-0866
Practice Address - Street 1:1260 HUNTINGTON DR STE 106
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4561
Practice Address - Country:US
Practice Address - Phone:626-317-0865
Practice Address - Fax:626-317-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care