Healthcare Provider Details

I. General information

NPI: 1932279072
Provider Name (Legal Business Name): GRAFTON SCHOOL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BELLVIEW AVE
WINCHESTER VA
22601-3142
US

IV. Provider business mailing address

120 BELLVIEW AVE
WINCHESTER VA
22601-3142
US

V. Phone/Fax

Practice location:
  • Phone: 540-542-0200
  • Fax: 540-542-0218
Mailing address:
  • Phone: 540-542-0200
  • Fax: 540-542-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number232
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number425
License Number StateWV

VIII. Authorized Official

Name: VANESSA LANE
Title or Position: DIRECTOR, CYCLE MNGT./ACCOUNTS RECE
Credential:
Phone: 540-542-0200