Provider Demographics
NPI:1962055343
Name:THE BERGAND GROUP LLC
Entity type:Organization
Organization Name:THE BERGAND GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:LIPPENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-853-7691
Mailing Address - Street 1:1803 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2501
Mailing Address - Country:US
Mailing Address - Phone:443-299-6766
Mailing Address - Fax:
Practice Address - Street 1:1803 HARFORD RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2501
Practice Address - Country:US
Practice Address - Phone:443-299-6766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4245491Medicaid