Gaudenzia Re-entry House | |
2100 W Venango St Philadelphia PA 19140-3937 | |
(215) 438-5082 | |
(215) 438-4159 |
Full Name | Gaudenzia Re-entry House |
---|---|
Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
Location | 2100 W Venango 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 Re-entry House 106 W Main St Norristown PA 19401-4716 Ph: (610) 239-9600 | Gaudenzia Re-entry House 2100 W Venango St Philadelphia PA 19140-3937 Ph: (215) 438-5082 |
NPI Number | 1083743975 |
---|---|
Provider Enumeration Date | 03/05/2007 |
Last Update Date | 06/21/2021 |
Certification Date | 06/21/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1083743975 | NPI | - | NPPES |
1002285890051 | Medicaid | PA | |
1002285890052 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 807308 (Pennsylvania) | Secondary |
261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | 807308 (Pennsylvania) | Primary |
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