Provider Demographics
NPI:1942732268
Name:GAUDENZIA INC
Entity Type:Organization
Organization Name:GAUDENZIA INC
Other - Org Name:GAUDENZIA REOAD TO RECOVERY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTING & FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:610-239-9600
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 1:3301 GREEN ST
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2052
Practice Address - Country:US
Practice Address - Phone:302-307-1300
Practice Address - Fax:302-384-7508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health