| NPI | 1366571317 |
|---|---|
| Other Name | GAUDENZIA BROAD STREET |
| Entity Type | Organization |
| Authorized Contact | MIKE WILLIAMS Sr. Contracting Manager 484-338-3731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: PA 807255) |
| Additional Taxonomies | 251S00000X (Licence: PA 807255) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2022-03-10 |