Provider Demographics
NPI:1730464165
Name:NEW HOPE YOUTH & FAMILY SERVICES OF GASTONIA
Entity Type:Organization
Organization Name:NEW HOPE YOUTH & FAMILY SERVICES OF GASTONIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:DEVONNE
Authorized Official - Last Name:SHANKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-361-5395
Mailing Address - Street 1:5736 N TRYON ST
Mailing Address - Street 2:SUITE 128
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6850
Mailing Address - Country:US
Mailing Address - Phone:704-361-5395
Mailing Address - Fax:980-207-5647
Practice Address - Street 1:615 S NEW HOPE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4808
Practice Address - Country:US
Practice Address - Phone:704-361-5395
Practice Address - Fax:980-207-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health