Basic Information
| Provider Information | |||||||||
| NPI: | 1932279072 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRAFTON SCHOOL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 BELLVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226013142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405420200 | ||||||||
| FaxNumber: | 5405420218 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 BELLVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226013142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405420200 | ||||||||
| FaxNumber: | 5405420218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 09/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | LANE | ||||||||
| AuthorizedOfficialFirstName: | VANESSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, CYCLE MNGT./ACCOUNTS RECE | ||||||||
| AuthorizedOfficialTelephone: | 5405420200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 425 | WV | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 320800000X | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 320900000X | N | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 323P00000X | 232 | VA | Y | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
ID Information
| ID | Type | State | Issuer | Description | 010002290 | 05 | VA | MEDICAID | 004945859 | 05 | VA | MEDICAID |