Provider Demographics
NPI:1700902897
Name:GENTLEMEN'S QUARTERS I., LLC.
Entity Type:Organization
Organization Name:GENTLEMEN'S QUARTERS I., LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:KATEAR
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:704-853-2665
Mailing Address - Street 1:105 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-2041
Mailing Address - Country:US
Mailing Address - Phone:704-853-2665
Mailing Address - Fax:704-853-2665
Practice Address - Street 1:801 S MAIN ST
Practice Address - Street 2:APT. 91
Practice Address - City:MOUNT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-2048
Practice Address - Country:US
Practice Address - Phone:704-820-9449
Practice Address - Fax:704-827-0718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-036-251101YM0800X, 320600000X
251S00000X, 310400000X, 311ZA0620X, 320800000X, 347C00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Not Answered347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty
Not Answered385H00000XRespite Care FacilityRespite Care