Healthcare Provider Details

I. General information

NPI: 1093859878
Provider Name (Legal Business Name): ALDIE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WELDEN DRIVE
DOYLESTOWN PA
18901
US

IV. Provider business mailing address

11 WELDEN DRIVE
DOYLESTOWN PA
18901
US

V. Phone/Fax

Practice location:
  • Phone: 215-345-8530
  • Fax: 215-345-5423
Mailing address:
  • Phone: 215-345-8530
  • Fax: 215-345-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberFACILITYNUMBER092344
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberFACILITYNUMBER092344
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number092344
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberFACILITYNUMBER092344
License Number StatePA

VIII. Authorized Official

Name: MR. GERALD BIRKELBACH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MRP
Phone: 215-345-8530