Provider Demographics
NPI:1962055343
Name:BERGAND GROUP
Entity type:Organization
Organization Name:BERGAND GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-853-7691
Mailing Address - Street 1:1300 YORK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6000
Mailing Address - Country:US
Mailing Address - Phone:410-853-7691
Mailing Address - Fax:
Practice Address - Street 1:1300 YORK RD STE 300
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6019
Practice Address - Country:US
Practice Address - Phone:410-853-7691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERGAND GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-24
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD379007000Medicaid