NPIMap

Organization Active NPI

Gaston Family Health Services, Inc.

Doing business as Kintegra Behavioral Health - Statesville

  • Federally Qualified Health Center (FQHC)
  • Statesville, NC
National Provider Identifier
1346098134
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GASTON FAMILY HEALTH SERVICES, INC.
Doing business as
Kintegra Behavioral Health - Statesville
Practice address
1450 Fern Creek Dr
Statesville, NC 28625-9376
Phone
(704) 818-9191
NPI assigned
May 8, 2024
Last updated
May 8, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GASTON FAMILY HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Authorized official

Name
Sharmila Alexander Anderson
Title
Revenue Cycle Manager
Phone
(704) 874-1907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1450 Fern Creek Dr
Statesville, NC 28625-9376

Mailing address

200 E 2ND Ave
Gastonia, NC 28052-4358

Other names 1

  • Kintegra Behavioral Health - Statesville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241209001554 NC Part A Provider - Federally Qualified Health Center (FQHC) 5496733925 Practice locations: Statesville, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346098134. Details of each certification follow.

Federally qualified health center certification: CCN B61058

Legal name
GASTON FAMILY HEALTH SERVICES INC
Doing business as
KINTEGRA BEHAVIORAL HEALTH - STATESVILLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 14, 2024
Last certification
Nov 14, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 28, 1991 in NC
Enrollment address
1450 Fern Creek Dr
Statesville, NC 28625-9376

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2171506Kintegra Behavioral Health - Statesville1450 Fern Creek Dr, Statesville, NC 28625Certificate of waiverSep 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Gaston Family Health SE264 organizations share this tax ID, including this one
Part of
Gaston Family Health SE

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1450 Fern Creek Dr
Statesville, NC 28625
Phone (704) 818-9191

Ownership & related parties

All disclosed owners & managing parties 21

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Shirley Stowe Individual Corporate Director Jul 21, 2014
Harold Thornburg Individual Corporate Director Jan 23, 2019
Sharmila Anderson Individual W-2 Managing Employee Jul 2, 2012
Jacobus Dodoo Individual Corporate Director Jul 21, 2014
Charles Luther Moore Individual Corporate Director Sep 28, 2022
John Herrera Individual Corporate Director Jul 21, 2014
James Hodges Individual Corporate Director Jul 21, 2014
Theresa Matthews Individual Corporate Director Jul 21, 2014
Ralph Luther Bentley Individual Corporate Director Jul 1, 2021
Robert Jones Individual Corporate Director Jul 21, 2014
Jennifer Foster McCracken Individual Corporate Director Jul 24, 2019
Robert Spencer Individual Corporate Officer Jan 8, 1996
Corporate Director Jan 8, 1996
W-2 Managing Employee Jan 8, 1996
Operational/Managerial Control Jan 8, 1996
James Macomson Individual Corporate Director Nov 28, 2018
Douglas Scarborough Individual Corporate Director Oct 26, 2022
Brian McGinnis Individual Corporate Director Jul 21, 2014
Ronald Worley Individual Corporate Director Nov 28, 2018
Kristin Hayes Monza Individual Corporate Director Apr 27, 2022
Michele Knapp Individual Corporate Director May 26, 2021
Paula Ratchford Black Individual Corporate Director Feb 25, 2021
Phillip Lee Hinely Individual Corporate Director Jul 21, 2014
Ramona Neal Individual Corporate Director Jul 21, 2014

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1715126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1346098134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E 2ND AVE",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280524358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 FERN CREEK DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286259376",
            "telephone_number": "704-818-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "enumeration_date": "2024-05-08",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHARMILA",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "704-874-1907"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kintegra Behavioral Health - Statesville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesville, NC

Sources for this page

Verify at the official NPI Registry.