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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	903022	MD

General Provider Information

NPI Number	:	1851504096
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	:	410-367-5501
Fax Number	:	410-367-4447

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	08/22/2020

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Directions to “GAUDENZIA INC ” Practice Location

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