Organization
GAUDENZIA INC
Active
Other names
GAUDENZIA NEW DESTINY
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE WILLIAMS (SR. CONTRACT MANAGER)
(484) 338-3731
Entity
Organization
Contact information
Practice address
91 BROAD STREET, ASHLAND, PA 17921
(570) 875-2287
(570) 875-2203
Mailing address
106 WEST MAIN STREET, NORRISTOWN, PA 19401-4716
(610) 239-9600
(610) 275-7025
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
547023
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002285890066
—
PA
Enumeration date
04/20/2007
Last updated
08/18/2021
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