NPIMap

Organization Active NPI

Gaudenzia Inc

  • Clinic/Center
  • Baltimore, MD
National Provider Identifier
1366656175
Registry record updated Jun 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
10478 Issued in MD
Legal business name
GAUDENZIA INC
Practice address
4615 Park Heights Ave
Baltimore, MD 21215-6331
Phone
(443) 423-1500
Fax
(443) 423-1495
NPI assigned
May 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2021

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

Authorized official

Name
Mike Williams
Title
Sr. Contracting Manager
Phone
(484) 338-3731

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 10478 MD Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 12536 MD

Addresses

Primary practice location

4615 Park Heights Ave
Baltimore, MD 21215-6331

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
4171233 00MedicaidMD

Other names 1

  • GAUDENZIA AT PARK HEIGHTS Other name

National Provider Directory

National Provider Directory
Tax ID family
Gaudenzia77 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624492800000",
    "number": "1366656175",
    "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": "4615 PARK HEIGHTS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212156331",
            "telephone_number": "443-423-1500",
            "fax_number": "443-423-1495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAUDENZIA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "SR. CONTRACTING MANAGER",
        "authorized_official_telephone_number": "484-338-3731"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MD",
            "license": "10478",
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MD",
            "license": "12536",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4171233 00",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GAUDENZIA AT PARK HEIGHTS",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "GAUDENZIA AT PARK HEIGHTS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; 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.