Provider Demographics
NPI:1295928356
Name:GASTON SKILLS, INC
Entity type:Organization
Organization Name:GASTON SKILLS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-869-0300
Mailing Address - Street 1:1301 BESSEMER CITY RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-1106
Mailing Address - Country:US
Mailing Address - Phone:704-869-0300
Mailing Address - Fax:704-869-9594
Practice Address - Street 1:1301 BESSEMER CITY RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-1106
Practice Address - Country:US
Practice Address - Phone:704-869-0300
Practice Address - Fax:704-869-9594
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GASTON SKILLS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300690BMedicaid