GASTON RESIDENTIAL SERVICES ICF/MR INC. NPI 1891859203

NPI Information

NPI: 1891859203
Provider Name: GASTON RESIDENTIAL SERVICES, ICF/MR, INC.
Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
1101 E FRANKLIN BLVD
GASTONIA, NC
ZIP 28054
Phone: (704) 861-9280
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GASTON RESIDENTIAL SERVICES, ICF/MR, INC. is an intermediate care facility mentally retarded in Gastonia, NC. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. GASTON RESIDENTIAL SERVICES, ICF/MR, INC. NPI is 1891859203. The provider is registered as an organization entity type.

The provider's business location address is:

1101 E FRANKLIN BLVD
GASTONIA, NC
ZIP 28054-251
Phone: (704) 861-9280
Fax: (704) 868-2154

The provider's authorized official is Jaimee D Weidert .
The authorized official title is Finance Director and has the following contact phone number (704) 861-9280.

The enumeration date for this NPI number is 12/20/2006 and was last updated on 4/8/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities	MHL-036-016	NORTH CAROLINA	No
2	315P00000X	Intermediate Care Facility, Intellectual Disabilities	MHL-036-011	NORTH CAROLINA	No
3	315P00000X	Intermediate Care Facility, Intellectual Disabilities	MHL-036-022	NORTH CAROLINA	No
4	315P00000X	Intermediate Care Facility, Intellectual Disabilities	MHL-036-069	NORTH CAROLINA	No
5	315P00000X	Intermediate Care Facility, Intellectual Disabilities	MHL-036-046	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	3406432	MEDICAID	NORTH CAROLINA
2	3406472	MEDICAID	NORTH CAROLINA
3	3406290	MEDICAID	NORTH CAROLINA
4	3406554	MEDICAID	NORTH CAROLINA
5	3406373	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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