MEDICARE: GAUDENZIA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	807397	PA
2	251S00000X	Community/Behavioral Health Agency	807397	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962536466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAUDENZIA, INC.

Provider Business Mailing Address
First Line	:	106 W MAIN ST
Second Line	:
City	:	NORRISTOWN
State	:	PA
Zip	:	19401-4716
Country	:	US
Telephone Number	:	610-239-9600
Fax Number	:	610-275-7025

Provider Business Practice Location Address
First Line	:	1516 WASHINGTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-5007
Country	:	US
Telephone Number	:	215-985-1200
Fax Number	:	215-985-0370

Authorized Official
Title or Position	:	SENIOR CONTRACTING CONSULTANT
Name	:	MIKE WILLIAMS
Credential	:
Telephone Number	:	484-338-3731

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	03/12/2022

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