| Gaudenzia Outreach I | |
|
1306 Spring Garden St Philadelphia PA 19123-3213 | |
| (215) 238-2150 | |
| (215) 238-2157 |
| Full Name | Gaudenzia Outreach I |
|---|---|
| Speciality | Clinic/center |
| Location | 1306 Spring Garden St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Michael J Moyle (DIR. OF FISCAL &CORPORATE OPERATION) |
| Authorized Official Contact | 6102399600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gaudenzia Outreach I 106 W Main St Norristown PA 19401-4716 Ph: (610) 239-9600 | Gaudenzia Outreach I 1306 Spring Garden St Philadelphia PA 19123-3213 Ph: (215) 238-2150 |
| NPI Number | 1245362482 |
|---|---|
| Provider Enumeration Date | 03/12/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245362482 | NPI | - | NPPES |
| 1002285890026 | Medicaid | PA | |
| 1002285890025 | Medicaid | PA | |
| 1002285890062 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 800146 (Pennsylvania) | Primary |
| 261Q00000X | Clinic/center | 800146 (Pennsylvania) | Primary |
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