| 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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