| Gaudenzia Drc Outpatient | |
|
3200 Henry Ave Philadelphia PA 19129-1137 | |
| (215) 991-9700 | |
| (215) 991-9796 |
| Full Name | Gaudenzia Drc Outpatient |
|---|---|
| Speciality | Clinic/center |
| Location | 3200 Henry Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Michael J Moyle (DIR. FISCAL & CORPORATE OPERASTIONS) |
| Authorized Official Contact | 6102399600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gaudenzia Drc Outpatient 106 W Main St Norristown PA 19401-4716 Ph: (610) 239-9600 | Gaudenzia Drc Outpatient 3200 Henry Ave Philadelphia PA 19129-1137 Ph: (215) 991-9700 |
| NPI Number | 1043434608 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 07/19/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043434608 | NPI | - | NPPES |
| 0019613780008 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 807384 (Pennsylvania) | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | 807384 (Pennsylvania) | Secondary |
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