Provider Demographics
NPI:1700629490
Name:BERGMANN CENTER, INC
Entity type:Organization
Organization Name:BERGMANN CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERI
Authorized Official - Middle Name:MEGAN
Authorized Official - Last Name:LAPORTE-MONTERO
Authorized Official - Suffix:
Authorized Official - Credentials:BA, QIDP
Authorized Official - Phone:231-547-2979
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-0236
Mailing Address - Country:US
Mailing Address - Phone:231-547-2979
Mailing Address - Fax:
Practice Address - Street 1:8855 MARTIN RD
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1089
Practice Address - Country:US
Practice Address - Phone:231-547-2979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health