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General NPI Number Information
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NPI Number | 1194840736
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Entity Type | Organization
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Legal Business Name | GAUDENZIA INC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 124 EAST AZALEA DRIVE ANDERSON HALL
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City | HARRISBURG
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State | PA
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Zip | 17110
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Country | US
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Telephone | 717-232-3232
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Fax | 717-236-6833
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Provider Business Mailing Address
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Address Line | 106 W MAIN ST
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City | NORRISTOWN
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State | PA
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Zip | 19401-4716
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Country | US
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Telephone | 610-239-9600
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Fax | 610-275-7025
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Authorized Official
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Title or Position | SENIOR CONTRACTING MANAGER
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Name | MIKE WILLIAMS
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Credential |
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Telephone | 484-338-3731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 221159
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License Number State | PA
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