Gaudenzia Drc Inc | |
3200 Henry Ave Philadelphia PA 19129-1137 | |
(215) 991-9700 | |
(215) 991-9796 |
Full Name | Gaudenzia Drc Inc |
---|---|
Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
Location | 3200 Henry Ave, Philadelphia, Pennsylvania |
Authorized Official Name and Position | Michael J Moyle (DIR. FISCAL & CORPORATE OPERATIONS) |
Authorized Official Contact | 6102399600 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Gaudenzia Drc Inc 106 W Main St Norristown PA 19401-4716 Ph: (610) 239-9600 | Gaudenzia Drc Inc 3200 Henry Ave Philadelphia PA 19129-1137 Ph: (215) 991-9700 |
NPI Number | 1073736104 |
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Provider Enumeration Date | 04/10/2007 |
Last Update Date | 07/19/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073736104 | NPI | - | NPPES |
0019613780009 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 800103 (Pennsylvania) | Secondary |
261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | 800103 (Pennsylvania) | Primary |
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