GAUDENZIA DRC INC NPI 1073736104

NPI Information

NPI: 1073736104
Provider Name: GAUDENZIA DRC INC
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

Address:
3200 HENRY AVE
PHILADELPHIA, PA
ZIP 19129
Phone: (215) 991-9700
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GAUDENZIA DRC INC is a rehabilitation and substance use disorder clinic center in Philadelphia, PA. GAUDENZIA DRC INC NPI is 1073736104. The provider is registered as an organization entity type.

The provider's business location address is:

3200 HENRY AVE
PHILADELPHIA, PA
ZIP 19129-137
Phone: (215) 991-9700
Fax: (215) 991-9796

The provider's authorized official is Michael J Moyle .
The authorized official title is Dir. Fiscal & Corporate Operations and has the following contact phone number (610) 239-9600.

The enumeration date for this NPI number is 4/10/2007 and was last updated on 7/19/2010.

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	261Q00000X	Clinic/Center		800103	PENNSYLVANIA	No
2	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	800103	PENNSYLVANIA	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	0019613780009	MEDICAID	PENNSYLVANIA

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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