Organization
GAUDENZIA INC
Active
Other names
GAUDENZIA RE-ENTRY HOUSE
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE WILLIAMS (SR. CONTRACTING MANAGER)
(484) 338-3731
Entity
Organization
Contact information
Practice address
2100 W VENANGO ST, PHILADELPHIA, PA 19140-3937
(215) 438-5082
(215) 438-4159
Mailing address
106 W MAIN ST, NORRISTOWN, PA 19401-4716
(610) 239-9600
(610) 275-7025
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
807308
PA
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
807308
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002285890051
—
PA
05
—
1002285890052
—
PA
Enumeration date
03/05/2007
Last updated
06/21/2021
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