Provider Demographics
NPI:1528210671
Name:NEW GENESIS RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:NEW GENESIS RESIDENTIAL SERVICES, INC.
Other - Org Name:LINCOLN CHILDRENS HOME NORTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-864-3600
Mailing Address - Street 1:3474 MAIDEN HWY
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-8047
Mailing Address - Country:US
Mailing Address - Phone:704-735-0579
Mailing Address - Fax:704-735-0579
Practice Address - Street 1:224 S NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4873
Practice Address - Country:US
Practice Address - Phone:704-864-3600
Practice Address - Fax:704-864-6142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-055-112322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children