Provider Demographics
NPI:1639329923
Name:GASTON SKILLS, INCORPORATED
Entity Type:Organization
Organization Name:GASTON SKILLS, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERM EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAXTER
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC001582251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherBEHAVIORAL HEALTH SERVICES
NC=========Medicaid
NC=========Medicare PIN