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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1457871311
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	:	3643 WOODLAND AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-5512
Country	:	US
Telephone Number	:	410-367-5551
Fax Number	:	410-367-4122

Authorized Official
Title or Position	:	SR. CONTRACTING MANAGER
Name	:	MIKE WILLIAMS
Credential	:
Telephone Number	:	484-338-3731

Provider Enumeration Date	:	06/22/2017
Last Update Date	:	06/24/2021

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Directions to “GAUDENZIA INC ” Practice Location

Language	Start Address	Practice Location

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