1932650744 NPI number — GAUDENZIA, INC.

Table of content: (NPI 1932650744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932650744 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 - FAMILY CENTER
Provider Other Organization Name Type Code:
3
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:
1932650744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3643 WOODLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21215-5512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-864-0674
Provider Business Mailing Address Fax Number:
410-367-1810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4613 PARK HEIGHTS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21215-6339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-779-4071
Provider Business Practice Location Address Fax Number:
410-664-0954
Provider Enumeration Date:
10/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. CONTRACTING MANAGER
Authorized Official Telephone Number:
484-338-3731

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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