NPIMap

Organization Active NPI

Gaston Residential Services, Icf/Mr, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Gastonia, NC
National Provider Identifier
1891859203
Registry record updated Apr 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
MHL-036-046 Issued in NC
Legal business name
GASTON RESIDENTIAL SERVICES, ICF/MR, INC.
Practice address
1101 E Franklin Blvd
Gastonia, NC 28054-4251
Phone
(704) 861-9280
Fax
(704) 868-2154
NPI assigned
Dec 20, 2006
Last updated
Apr 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2019

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

Authorized official

Name
Jaimee D Weidert
Title
Finance Director
Phone
(704) 861-9280

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL-036-022 NC
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL-036-069 NC
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL-036-016 NC
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL-036-011 NC
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL-036-046 NC Primary

Addresses

Primary practice location

1101 E Franklin Blvd
Gastonia, NC 28054-4251

Mailing address

905A N New Hope Rd
Gastonia, NC 28054-3354
Phone (704) 861-9280

Other identifiers 5

IdentifierTypeStateIssuer
3406373MedicaidNC
3406290MedicaidNC
3406472MedicaidNC
3406432MedicaidNC
3406554MedicaidNC

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.

Locations

1101 E Franklin Blvd
Gastonia, NC 28054

NPI Registry JSON

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554681600000",
    "number": "1891859203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905A N NEW HOPE RD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280543354",
            "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": "1101 E FRANKLIN BLVD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544251",
            "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": "2006-12-20",
        "last_updated": "2019-04-08",
        "status": "A",
        "authorized_official_last_name": "WEIDERT",
        "authorized_official_first_name": "JAIMEE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "704-861-9280"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL-036-022",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL-036-069",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL-036-016",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL-036-011",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL-036-046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406373",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406290",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406472",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406432",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406554",
            "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 8, 2019; 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.