Organization
GAUDENZIA INC
Active
Other names
GAUDENZIA VANTAGE HOUSE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J MOYLE J.D. (DIR. FISCAL & CORPORATE OPERATIONS)
(610) 239-9600
Entity
Organization
Contact information
Practice address
208 E KING ST, LANCASTER, PA 17602-2927
(717) 291-1020
(717) 293-9064
Mailing address
106 W MAIN ST, 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
367044
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002285890087
—
PA
Enumeration date
03/19/2007
Last updated
02/06/2023
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