Organization
GASTON RESIDENTIAL SERVICES, ICF/MR, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LYNETTE G DEMPERIO (FINANCE DIRECTOR)
(704) 861-9280
Entity
Organization
Contact information
Practice address
934 SPRINGDALE LN, GASTONIA, NC 28052-5327
(704) 861-9280
(704) 868-2154
Mailing address
905 N NEW HOPE RD STE A, GASTONIA, NC 28054-3373
(704) 861-9280
(704) 868-2154
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3406290
—
NC
Enumeration date
05/22/2009
Last updated
05/22/2009
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