Provider Demographics
NPI:1700051356
Name:GAUDENZIA, INC.
Entity Type:Organization
Organization Name:GAUDENZIA, INC.
Other - Org Name:GAUDENZIA MONTGOMERY COUNTY OP
Other - Org Type:Other Name
Authorized Official - Title/Position: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:
Practice Address - Street 1:166 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-4716
Practice Address - Country:US
Practice Address - Phone:610-279-4262
Practice Address - Fax:610-278-1658
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GAUDENZIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-24
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1002285890109Medicaid