Organization
GASTON RESIDENTIAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS G DAVIS CPA (FINANCE DIRECTOR)
(704) 861-9280
Entity
Organization
Contact information
Practice address
905A N NEW HOPE RD, GASTONIA, NC 28054-3354
(704) 861-9280
(704) 868-2154
Mailing address
905A N NEW HOPE RD, GASTONIA, NC 28054-3354
(704) 861-9280
(704) 868-2154
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MHL-036-023
LAUREL LANE G.H.
NC
01
—
MHL-036-049
YORK CHESTER G.H.
NC
01
—
MHL-036-051
FORESTBROOK G.H.
NC
01
—
MHL-036-060
GARDNER PARK G.H.
NC
01
—
MHL-036-174
SECOND AVE. HOME
NC
01
—
MHL-036-239
FAIRVIEW GROUP HOME
NC
Enumeration date
12/26/2006
Last updated
09/13/2021
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