Gaudenzia Inc
Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Ashland, PA
NPI 1093933749 · NPPES record last updated Aug 18, 2021
Key facts
- NPI
- 1093933749
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
- License
- 547023 (PA)
- Legal business name
- GAUDENZIA INC
- Practice address
- 91 Broad Street
Ashland, PA 17921 - Phone
- (570) 875-2287
- Fax
- (570) 875-2203
- NPI assigned
- Apr 20, 2007
- Organization subpart
- No
Authorized official
- Name
- Mike Williams
- Title
- Sr. Contract Manager
- Phone
- (484) 338-3731
Corporate family (same tax ID) 16
National Provider Directory
- Tax ID family
- Gaudenzia
Locations
91 Broad St
Ashland, PA 17921
Phone (570) 875-2287
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | 547023 | PA | Yes |
Addresses
Primary practice location
91 Broad Street
Ashland, PA 17921
Mailing address
106 West Main Street
Norristown, PA 19401-4716
Phone (610) 239-9600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1002285890066 | Medicaid | PA |
Other names
- GAUDENZIA NEW DESTINY
Other providers in Ashland, PA
- Cornerstone Coordinated Health Care, LLC
- Cornerstone Coordinated Health Care, LLC
- Jamie Lynn Damiter
- Kelly Marie Dranginis
- Robert Flannery
- Gaudenzia Inc
- Mark David Gernerd
- Janice Marie Hale
- Wendy Header
- Mary Ann Horsfield
All providers in Ashland, PA · Substance Use Disorder Rehabilitation Clinic/Center in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.