GAUDENZIA INC NPI 1083743975

NPI Information

NPI: 1083743975
Provider Name: GAUDENZIA INC

Other Name: GAUDENZIA RE-ENTRY HOUSE

Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

Address:
2100 W VENANGO ST
PHILADELPHIA, PA
ZIP 19140
Phone: (215) 438-5082
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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
1	251S00000X	Community/Behavioral Health		807308	PENNSYLVANIA	No
2	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	807308	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	1002285890051	MEDICAID	PENNSYLVANIA
2	1002285890052	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

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