Provider Demographics
NPI:1245376151
Name:GASTON COUNTY DEPARTMENT OF SOCIAL SERVICES
Entity type:Organization
Organization Name:GASTON COUNTY DEPARTMENT OF SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-862-7540
Mailing Address - Street 1:330 N MARIETTA ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-2332
Mailing Address - Country:US
Mailing Address - Phone:704-862-7540
Mailing Address - Fax:704-862-7677
Practice Address - Street 1:330 N MARIETTA ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-2332
Practice Address - Country:US
Practice Address - Phone:704-862-7540
Practice Address - Fax:704-862-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700031Medicaid
NC3408308Medicaid