NPIMap

Organization Active NPI

Gaudenzia DRC Inc

  • Clinic/Center
  • Philadelphia, PA
National Provider Identifier
1043434608
Registry record updated Jul 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
807384 Issued in PA
Legal business name
GAUDENZIA DRC INC
Practice address
3200 Henry Ave
Philadelphia, PA 19129-1137
Phone
(215) 991-9700
Fax
(215) 991-9796
NPI assigned
Apr 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael J Moyle, J.D.
Title
Dir. Fiscal & Corporate Operastions
Phone
(610) 239-9600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 807384 PA Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 807384 PA

Addresses

Primary practice location

3200 Henry Ave
Philadelphia, PA 19129-1137

Mailing address

106 W Main St
Norristown, PA 19401-4716
Phone (610) 239-9600

Other identifiers 1

IdentifierTypeStateIssuer
0019613780008MedicaidPA

Other names 1

  • GAUDENZIA DRC OUTPATIENT Other name

National Provider Directory

National Provider Directory
Tax ID family
Gaudenzia DRC Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279497600000",
    "number": "1043434608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 W MAIN ST",
            "city": "NORRISTOWN",
            "state": "PA",
            "postal_code": "194014716",
            "telephone_number": "610-239-9600",
            "fax_number": "610-275-7025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 HENRY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291137",
            "telephone_number": "215-991-9700",
            "fax_number": "215-991-9796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAUDENZIA DRC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2010-07-19",
        "status": "A",
        "authorized_official_last_name": "MOYLE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIR. FISCAL & CORPORATE OPERASTIONS",
        "authorized_official_telephone_number": "610-239-9600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "J.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "PA",
            "license": "807384",
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "PA",
            "license": "807384",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019613780008",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GAUDENZIA DRC OUTPATIENT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.