Basic Information
| Provider Information | |||||||||
| NPI: | 1720159676 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GRAFTON SCHOOL, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | GRAFTON INTEGRATED HEALTH NETWORK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 BELLVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405420200 | ||||||||
| FaxNumber: | 5405420318 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 BELLVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405420200 | ||||||||
| FaxNumber: | 5405420318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 05/05/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LANE | ||||||||
| AuthorizedOfficialFirstName: | VANESSA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, CYCLE MNGT./ACCOUNTS RECE | ||||||||
| AuthorizedOfficialTelephone: | 5405420200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | 232 | VA | N | Agencies | Day Training, Developmentally Disabled Services | 320900000X | 232 | VA | Y | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 1720159676 | 05 | VA | MEDICAID |