NPIMap

Organization Active NPI

Lutheran Family Services in the Carolinas

  • Intellectual Disabilities Intermediate Care Facility
  • Gastonia, NC
National Provider Identifier
1851447221
Registry record updated Jun 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
MHL036031 Issued in NC
Legal business name
LUTHERAN FAMILY SERVICES IN THE CAROLINAS
Practice address
810 King Arthur Dr
Gastonia, NC 28056-8469
Phone
(704) 824-8941
NPI assigned
Jan 26, 2007
Organization subpart
Yes
Parent organization
LUTHERAN FAMILY SERVICES IN THE CAROLINASAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 26, 2017

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

Authorized official

Name
Mr. Kirby Nickerson
Title
Chief Financial Officer
Phone
(704) 754-8228

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL036031 NC Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-036-031 NC

Addresses

Primary practice location

810 King Arthur Dr
Gastonia, NC 28056-8469

Mailing address

PO Box 2369
Salisbury, NC 28145-2369
Phone (704) 637-2870

Other identifiers 1

IdentifierTypeStateIssuer
3416485MedicaidNC

Other names 1

  • Mountain Ridge Group Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lutheran Counseling Cen29 organizations share this tax ID, including this one
Part of
Lutheran Counseling Cen

Other organizations with this tax ID 28

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

View all 28

Locations

810 King Arthur Dr
Gastonia, NC 28056
Phone (704) 824-8941

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498435200000",
    "number": "1851447221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2369",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281452369",
            "telephone_number": "704-637-2870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 KING ARTHUR DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280568469",
            "telephone_number": "704-824-8941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN FAMILY SERVICES IN THE CAROLINAS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUTHERAN FAMILY SERVICES IN THE CAROLINAS",
        "enumeration_date": "2007-01-26",
        "last_updated": "2017-06-26",
        "status": "A",
        "authorized_official_last_name": "NICKERSON",
        "authorized_official_first_name": "KIRBY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "704-754-8228",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL036031",
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-036-031",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3416485",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Ridge Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 26, 2017; 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.