1831222751 NPI number — GAUDENZIA INC

Table of content: (NPI 1831222751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831222751 NPI number — GAUDENZIA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAUDENZIA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GAUDENZIA OUTREACH II
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831222751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORRISTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19401-4716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-239-9600
Provider Business Mailing Address Fax Number:
610-275-7025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 E SCHOOL HOUSE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19144-2234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-849-7200
Provider Business Practice Location Address Fax Number:
215-849-0134
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOYLE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIR. OF FISCAL & CORPORATE OPERATIO
Authorized Official Telephone Number:
610-239-9600

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  807339 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261Q00000X , with the licence number: 807339 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1002285890003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1002285890002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1002285890006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1002285890059 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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