Organization
GASTON RESIDENTIAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS G DAVIS (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
05
—
3408863
—
NC
05
—
7802058
—
NC
05
—
7802105
—
NC
05
—
7802582
—
NC
05
—
7804622
—
NC
05
—
8300506
—
NC
01
—
MHL-036-239
FAIRVIEW GROUP HOME LICENSE
NC
Enumeration date
12/21/2006
Last updated
09/13/2021
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