GAUDENZIA INC NPI 1083743975

NPI Information

  • NPI: 1083743975
  • Provider Name: GAUDENZIA INC
  • Classification: Clinic/Center - 261QR0405X
  • Specialization: Rehabilitation, Substance Use Disorder
  • Entity Type: Organization
  • Other Name: GAUDENZIA RE-ENTRY HOUSE
  • CLIA Number: 39D2221254
  • Address: 2100 W VENANGO ST
    PHILADELPHIA, PA
    ZIP 19140
  • Phone: (215) 438-5082

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NPI Details

GAUDENZIA INC is a rehabilitation and substance use disorder clinic center in Philadelphia, PA. GAUDENZIA INC NPI is 1083743975. The provider is registered as an organization entity type.
The provider Other Name Is Gaudenzia Re-entry House.

The provider's business location address is:

2100 W VENANGO ST
PHILADELPHIA, PA
ZIP 19140-937
Phone: (215) 438-5082
Fax: (215) 438-4159

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 39D2221254 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/5/2007 and was last updated on 6/21/2021.

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
1251S00000XCommunity/Behavioral Health807308PENNSYLVANIANo
2261QR0405XClinic/CenterRehabilitation, Substance Use Disorder807308PENNSYLVANIAYes

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
11002285890051MEDICAIDPENNSYLVANIA
21002285890052MEDICAIDPENNSYLVANIA

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: 11/21/2025

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