Provider Demographics
NPI:1376886721
Name:GAUDENZIA.ORG
Entity Type:Organization
Organization Name:GAUDENZIA.ORG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. 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 1:4615 PARK HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-6331
Mailing Address - Country:US
Mailing Address - Phone:410-367-4447
Mailing Address - Fax:410-367-4447
Practice Address - Street 1:4615 PARK HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-6331
Practice Address - Country:US
Practice Address - Phone:410-367-4447
Practice Address - Fax:410-367-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD904854324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417123300Medicare PIN