Provider Demographics
NPI:1104261585
Name:GAUDENZIA, INC
Entity type:Organization
Organization Name:GAUDENZIA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:410-367-5501
Mailing Address - Street 1:3643 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5512
Mailing Address - Country:US
Mailing Address - Phone:443-869-6298
Mailing Address - Fax:443-849-6433
Practice Address - Street 1:4450 PARK HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-6324
Practice Address - Country:US
Practice Address - Phone:443-869-6298
Practice Address - Fax:443-869-6433
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GAUDENZIA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable