NPIMap

Organization Active NPI

G & D Residential Services, LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Greensboro, NC
National Provider Identifier
1003012758
Registry record updated Jun 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
MHL-041-764 Issued in NC
Legal business name
G & D RESIDENTIAL SERVICES, LLC
Practice address
620 Guilford College Rd Ste G
Greensboro, NC 27409-2027
Phone
(336) 254-6770
Fax
(336) 292-1589
NPI assigned
Jun 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Geovon Kenane Martin
Title
Ceo Director
Phone
(336) 254-6770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X MHL-041-764 NC Primary

Addresses

Primary practice location

620 Guilford College Rd Ste G
Greensboro, NC 27409-2027

Mailing address

620 Guilford College Rd Ste G
Greensboro, NC 27409-2027
Phone (336) 254-6770

Other identifiers 1

IdentifierTypeStateIssuer
8300792BMedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
G D Residential Services LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243814400000",
    "number": "1003012758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 GUILFORD COLLEGE RD STE G",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274092027",
            "telephone_number": "336-254-6770",
            "fax_number": "336-292-1589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 GUILFORD COLLEGE RD STE G",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274092027",
            "telephone_number": "336-254-6770",
            "fax_number": "336-292-1589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G & D RESIDENTIAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2009-06-01",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "GEOVON",
        "authorized_official_middle_name": "KENANE",
        "authorized_official_title_or_position": "CEO DIRECTOR",
        "authorized_official_telephone_number": "336-254-6770",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-041-764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300792B",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.