Basic Information
| Provider Information | |||||||||
| NPI: | 1972061497 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GAUDENZIA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 W MAIN ST | ||||||||
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| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194014716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102399600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 105 CIRCLE DRIVE | ||||||||
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| City: | CROWNSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210322061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435986900 | ||||||||
| FaxNumber: | 4439236781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2019 | ||||||||
| LastUpdateDate: | 03/04/2019 | ||||||||
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| AuthorizedOfficialLastName: | COYLE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR ACCOUNTING & FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 6102399600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.