Provider Demographics
NPI:1871742361
Name:NEW GENESIS RESIDENTIAL SERVICES, INC.
Entity type:Organization
Organization Name:NEW GENESIS RESIDENTIAL SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:224 S NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4873
Mailing Address - Country:US
Mailing Address - Phone:704-864-3600
Mailing Address - Fax:704-864-6142
Practice Address - Street 1:3020 ARNOLD DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-7504
Practice Address - Country:US
Practice Address - Phone:704-482-8908
Practice Address - Fax:704-482-8908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-023-144322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children