Provider Demographics
NPI:1457322448
Name:BURDMAN GROUP, INC.
Entity Type:Organization
Organization Name:BURDMAN GROUP, INC.
Other - Org Name:RIVERBEND CENTER
Other - Org Type:Doing Business As
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 1:3120 W MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-3069
Practice Address - Country:US
Practice Address - Phone:330-898-6692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0605251B00000X
OH04-1822320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2497605Medicaid
OH10088Medicaid
OH2497605Medicaid