Healthcare Provider Details

I. General information

NPI: 1447384367
Provider Name (Legal Business Name): GAUDENZIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 SPRING GARDEN ST 2ND AND 3RD FLOORS
PHILADELPHIA PA
19123-3213
US

IV. Provider business mailing address

106 W MAIN ST
NORRISTOWN PA
19401-4716
US

V. Phone/Fax

Practice location:
  • Phone: 215-413-8268
  • Fax: 215-413-8276
Mailing address:
  • Phone: 610-239-9600
  • Fax: 610-275-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number850179
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number850179
License Number StatePA

VIII. Authorized Official

Name: MR. MICHAEL J MOYLE
Title or Position: DIR. FISCAL & CORPORATE OPERATIONS
Credential: J.D.
Phone: 610-239-9600