NPIMap

Organization Active NPI

Gaston Residential Services, Icf/Mr, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Gastonia, NC
National Provider Identifier
1689809493
Registry record updated May 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
GASTON RESIDENTIAL SERVICES, ICF/MR, INC.
Practice address
934 Springdale LN
Gastonia, NC 28052-5327
Phone
(704) 861-9280
Fax
(704) 868-2154
NPI assigned
May 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2009

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

Authorized official

Name
Ms. Lynette G Demperio
Title
Finance Director
Phone
(704) 861-9280

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

934 Springdale LN
Gastonia, NC 28052-5327

Mailing address

905 N New Hope Rd Ste a
Gastonia, NC 28054-3373
Phone (704) 861-9280

Other identifiers 1

IdentifierTypeStateIssuer
3406290MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Gaston Residential Services Icfmr Inc5 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": "1242950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242950400000",
    "number": "1689809493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 N NEW HOPE RD STE A",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280543373",
            "telephone_number": "704-861-9280",
            "fax_number": "704-868-2154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "934 SPRINGDALE LN",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280525327",
            "telephone_number": "704-861-9280",
            "fax_number": "704-868-2154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON RESIDENTIAL SERVICES, ICF/MR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-22",
        "last_updated": "2009-05-22",
        "status": "A",
        "authorized_official_last_name": "DEMPERIO",
        "authorized_official_first_name": "LYNETTE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "704-861-9280",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406290",
            "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 May 22, 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.