Organization
GAUDENZIA DRC INC
Active
Other names
GAUDENZIA DRC OUTPATIENT
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J MOYLE J.D. (DIR. FISCAL & CORPORATE OPERASTIONS)
(610) 239-9600
Entity
Organization
Contact information
Practice address
3200 HENRY AVE, PHILADELPHIA, PA 19129-1137
(215) 991-9700
(215) 991-9796
Mailing address
106 W MAIN ST, NORRISTOWN, PA 19401-4716
(610) 239-9600
(610) 275-7025
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
807384
PA
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
807384
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019613780008
—
PA
Enumeration date
04/12/2007
Last updated
07/19/2010
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