Organization
GAUDENZIA INC
Active
Other names
GAUDENZIA FOUNTAIN SPRINGS
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
95 BROAD ST, ASHLAND, PA 17921-2101
(570) 875-4700
(570) 875-4260
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
547013
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002285890035
—
PA
05
—
1002285890036
—
PA
Enumeration date
03/20/2007
Last updated
08/22/2020
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