| Gaudenzia New Image | |
|
1300 E Tulpehocken St Philadelphia PA 19138-1523 | |
| (215) 924-6322 | |
| (215) 924-5531 |
| Full Name | Gaudenzia New Image |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 1300 E Tulpehocken 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 New Image 106 W Main St Norristown PA 19401-4716 Ph: (610) 239-9600 | Gaudenzia New Image 1300 E Tulpehocken St Philadelphia PA 19138-1523 Ph: (215) 924-6322 |
| NPI Number | 1730212861 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 03/10/2022 |
| Certification Date | 03/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730212861 | NPI | - | NPPES |
| 1002285890047 | Medicaid | PA | |
| 1002285890048 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 807230 (Pennsylvania) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | 807230 (Pennsylvania) | Primary |
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