Provider Demographics
NPI:1922180652
Name:GAUDENZIA INC
Entity Type:Organization
Organization Name:GAUDENZIA INC
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 1:106 W MAIN ST STE 202
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:814-616-6335
Practice Address - Street 1:414 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1214
Practice Address - Country:US
Practice Address - Phone:814-459-4775
Practice Address - Fax:814-453-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
PA251086324500000X
PA257046324500000X
PA257048324500000X
PA257079324500000X
PA257080324500000X
PA257081324500000X
PA257082324500000X
PA257083324500000X
PA437029324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0815OtherBLUE CROSS BLUE SHEILD
PA459802OtherVALUE OPTIONS
PAVO543BOtherUPMC
PA0018923880001Medicaid
PA1018307530003Medicaid
PA60054OtherAETNA
PA0018923880001OtherCCBHO