Basic Information
| Provider Information | |||||||||
| NPI: | 1649722349 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GAUDENZIA INC | ||||||||
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| OtherOrganizationName: | GAUDENZIA NEW LOOK RESIDENTIAL TREATMENT FACILITY FOR ADULTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194014716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102399600 | ||||||||
| FaxNumber: | 6102757025 | ||||||||
| Practice Location | |||||||||
| Address1: | 1306 SPRING GARDEN ST | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191233213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2678191220 | ||||||||
| FaxNumber: | 2154138274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2016 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | MIKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. CONTRACTING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4843383731 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 323P00000X | 142750 | PA | Y | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
No ID Information.