Provider Demographics
NPI:1972061497
Name:GAUDENZIA, INC.
Entity type:Organization
Organization Name:GAUDENZIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR ACCOUNTING & FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:610-239-9600
Mailing Address - Street 1:106 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-4716
Mailing Address - Country:US
Mailing Address - Phone:610-239-9600
Mailing Address - Fax:
Practice Address - Street 1:105 CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-2061
Practice Address - Country:US
Practice Address - Phone:443-598-6900
Practice Address - Fax:443-923-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder