GAUDENZIA NPI 1215256417

NPI Information

NPI: 1215256417
Provider Name: GAUDENZIA
Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization

CLIA Number: 21D2204823

Address:
4615 PARK HEIGHTS AVE
BALTIMORE, MD
ZIP 21215
Phone: (443) 423-1500
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GAUDENZIA is a substance abuse rehabilitation facility in Baltimore, MD. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. GAUDENZIA NPI is 1215256417. The provider is registered as an organization entity type.

The provider's business location address is:

4615 PARK HEIGHTS AVE
BALTIMORE, MD
ZIP 21215-331
Phone: (443) 423-1500
Fax: (443) 423-1495

The provider's authorized official is Mike Williams .
The authorized official title is Sr. Contracting Manager and has the following contact phone number (484) 338-3731.

The CLIA number assigned to this NPI record is 21D2204823 - other - residential tx with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/27/2010 and was last updated on 6/24/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	903027	MARYLAND	No
2	324500000X	Substance Abuse Rehabilitation Facility		903027	MARYLAND	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	405006100	MEDICAID	MARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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