Provider Demographics
NPI:1194840736
Name:GAUDENZIA INC
Entity Type:Organization
Organization Name:GAUDENZIA INC
Other - Org Name:GAUDENZIA CONCEPT 90
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR CONTRACTING 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:610-275-7025
Practice Address - Street 1:124 EAST AZALEA DRIVE
Practice Address - Street 2:ANDERSON HALL
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110
Practice Address - Country:US
Practice Address - Phone:717-232-3232
Practice Address - Fax:717-236-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA221159261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1002285890037Medicaid
PA1002285890038Medicaid