NPIMap

Organization Active NPI

Gaudenzia

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Philadelphia, PA
National Provider Identifier
1922273564
Registry record updated Jul 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
807404 Issued in PA
Legal business name
GAUDENZIA
Practice address
1834 W Tioga St
Philadelphia, PA 19140-4939
Phone
(215) 228-7595
Fax
(215) 965-7779
NPI assigned
Apr 24, 2008
Last updated
Jul 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2026

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 807404 PA Primary

Addresses

Primary practice location

1834 W Tioga St
Philadelphia, PA 19140-4939

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1002285890071MedicaidPA

Other names 1

  • GAUDENZIA WINNER PROGRAM 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 16

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

View all 16

Locations

166 W Main St
Norristown, PA 19401
Phone (443) 327-9767

1834 W Tioga St
Philadelphia, PA 19140
Phone (215) 228-7595

NPI Registry JSON

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784764800000",
    "number": "1922273564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 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": "1834 W TIOGA ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404939",
            "telephone_number": "215-228-7595",
            "fax_number": "215-965-7779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAUDENZIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2026-07-23",
        "certification_date": "2026-07-23",
        "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": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "PA",
            "license": "807404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1002285890071",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GAUDENZIA WINNER PROGRAM",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "GAUDENZIA WINNER PROGRAM",
            "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 23, 2026; 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.