Provider Demographics
NPI:1295181170
Name:GAUDENZIA, INC.
Entity Type:Organization
Organization Name:GAUDENZIA, INC.
Other - Org Name:GAUDENZIA - GLEN BURNIE OUTPATIENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:YOUTHFUL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-980-1519
Mailing Address - Street 1:106 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-5512
Mailing Address - Country:US
Mailing Address - Phone:610-239-9600
Mailing Address - Fax:610-275-7020
Practice Address - Street 1:5 CRAIN HIGHWAY NORTH - REAR SUITE ENTRANCE
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:443-569-7950
Practice Address - Fax:410-367-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty