Provider Demographics
NPI:1083656383
Name:GRAFTON ASSOCIATES LIMITED PARTNERSHIP PTR
Entity Type:Organization
Organization Name:GRAFTON ASSOCIATES LIMITED PARTNERSHIP PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-276-4040
Mailing Address - Street 1:405 GRAFTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-5202
Mailing Address - Country:US
Mailing Address - Phone:937-276-4040
Mailing Address - Fax:937-276-4555
Practice Address - Street 1:405 GRAFTON AVENUE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-5202
Practice Address - Country:US
Practice Address - Phone:937-276-4040
Practice Address - Fax:937-276-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4063314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0730043Medicaid
OH0730043Medicaid
OH365716Medicare Oscar/Certification