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	261Q00000X	Clinic/Center
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

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	:	1700051356
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	:

Provider Business Practice Location Address
First Line	:	166 W MAIN ST
Second Line	:
City	:	NORRISTOWN
State	:	PA
Zip	:	19401-4716
Country	:	US
Telephone Number	:	610-279-4262
Fax Number	:	610-278-1658

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

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	05/18/2022

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Directions to “GAUDENZIA, INC. ” Practice Location

Language	Start Address	Practice Location

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