Organization
GAUDENZIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE WILLIAMS (SR. CONTRACTING MANAGER)
(484) 338-3731
Entity
Organization
Contact information
Practice address
4615 PARK HEIGHTS AVE, BALTIMORE, MD 21215-6331
(443) 423-1500
(443) 423-1495
Mailing address
4615 PARK HEIGHTS AVE, BALTIMORE, MD 21215-6331
(443) 423-1500
(443) 423-1495
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
903027
MD
324500000X
Substance Abuse Rehabilitation Facility
Primary
903027
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405006100
—
MD
Enumeration date
05/27/2010
Last updated
06/24/2021
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