| Gaudenzia Broad Street | |
|
3025 N Broad St Philadelphia PA 19132-2404 | |
| (215) 223-1167 | |
| (215) 223-1928 |
| Full Name | Gaudenzia Broad Street |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 3025 N Broad St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Mike Williams (SR. CONTRACTING MANAGER) |
| Authorized Official Contact | 4843383731 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gaudenzia Broad Street 106 W Main St Norristown PA 19401-4716 Ph: (610) 236-9600 | Gaudenzia Broad Street 3025 N Broad St Philadelphia PA 19132-2404 Ph: (215) 223-1167 |
| NPI Number | 1366571317 |
|---|---|
| Provider Enumeration Date | 03/05/2007 |
| Last Update Date | 03/10/2022 |
| Certification Date | 03/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366571317 | NPI | - | NPPES |
| 1002285890053 | Medicaid | PA | |
| 1002285890054 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 807255 (Pennsylvania) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | 807255 (Pennsylvania) | Primary |
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