Active NPI
Genesis House, Inc.
- Case Management Agency
- Gastonia, NC
National Provider Identifier
1487958716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Management Agency
- Legal business name
- GENESIS HOUSE, INC.
- Practice address
- 549 Cox Rd
Suite a
Gastonia, NC 28054-0628 - Phone
- (704) 852-3778
- NPI assigned
- Dec 30, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kelvin Hall
- Title
- President/Ceo
- Phone
- (704) 852-3778
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Prescribing (Medical) Psychologist | 103TP0016X | |||
| Case Management Agency | 251B00000X | Primary | ||
| Community/Behavioral Health Agency | 251S00000X |
Addresses
Primary practice location
549 Cox Rd
Suite a
Gastonia, NC 28054-0628
Mailing address
PO Box 551389
Gastonia, NC 28055-1389
Phone (704) 852-3778
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8300892G | Medicaid | NC | |
| 8303041R | Medicaid | NC | |
| 8702052 | Medicaid | NC | |
| 5914113 | Medicaid | NC | |
| 6002315 | Medicaid | NC | |
| 6005952 | Medicaid | NC | |
| 8300892H | Medicaid | NC | |
| 8300892V | Medicaid | NC | |
| 8703125 | Medicaid | NC | |
| 8302550 | Medicaid | NC | |
| 8302550V | Medicaid | NC | |
| 8921979 | Medicaid | NC |
National Provider Directory
National Provider DirectoryLocations
549 Cox Rd
#A
Gastonia, NC 28054
Phone (704) 852-3778
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Clinical Social Worker
- Dallas, NC
- NPI 1063693174
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1293667200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1334102400000",
"number": "1487958716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 551389",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280551389",
"telephone_number": "704-852-3778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "549 COX RD",
"address_2": "SUITE A",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280540628",
"telephone_number": "704-852-3778"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GENESIS HOUSE, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2010-12-30",
"last_updated": "2012-04-11",
"status": "A",
"authorized_official_last_name": "HALL",
"authorized_official_first_name": "KELVIN",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "704-852-3778"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TP0016X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Prescribing (Medical)",
"state": null,
"license": null,
"primary": false
},
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": null,
"license": null,
"primary": true
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8300892G",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8303041R",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8702052",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5914113",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6002315",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6005952",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8300892H",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8300892V",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8703125",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8302550",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8302550V",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8921979",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Gastonia, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.