Provider Demographics
NPI:1194455477
Name:GAUDENZIA, INC.
Entity Type:Organization
Organization Name:GAUDENZIA, INC.
Other - Org Name:GAUDENZIA GLEN BURNIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-338-3731
Mailing Address - Street 1:106 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-4716
Mailing Address - Country:US
Mailing Address - Phone:610-239-9600
Mailing Address - Fax:610-275-7022
Practice Address - Street 1:5 CRAIN HWY N
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2803
Practice Address - Country:US
Practice Address - Phone:443-569-7950
Practice Address - Fax:410-787-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health