Provider Demographics
NPI:1558881417
Name:GAUDENZIA INC
Entity Type:Organization
Organization Name:GAUDENZIA INC
Other - Org Name:GAUDENZIA CROWNSVILLE
Other - Org Type:Other Name
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:19401-4716
Mailing Address - Country:US
Mailing Address - Phone:610-239-9600
Mailing Address - Fax:610-275-7025
Practice Address - Street 1:107 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-2061
Practice Address - Country:US
Practice Address - Phone:443-598-6900
Practice Address - Fax:410-923-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility