Provider Demographics
NPI:1134342165
Name:ALDIE FOUNDATION
Entity type:Organization
Organization Name:ALDIE FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRKELBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MRP
Authorized Official - Phone:215-345-8530
Mailing Address - Street 1:2291 CABOT BLVD W
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1806
Mailing Address - Country:US
Mailing Address - Phone:215-642-3230
Mailing Address - Fax:215-642-3234
Practice Address - Street 1:2291 CABOT BLVD W
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1806
Practice Address - Country:US
Practice Address - Phone:215-642-3230
Practice Address - Fax:215-642-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA092344261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100727874 0005Medicaid
PA715427Medicare ID - Type UnspecifiedPROVIDER ID