Provider Demographics
NPI:1659491157
Name:THE GRAHAM HOME
Entity Type:Organization
Organization Name:THE GRAHAM HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:FAIRCLOTH
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:910-592-8303
Mailing Address - Street 1:501 MCKOY ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2516
Mailing Address - Country:US
Mailing Address - Phone:910-592-8303
Mailing Address - Fax:910-557-3168
Practice Address - Street 1:634 FOX RD
Practice Address - Street 2:
Practice Address - City:MARSTON
Practice Address - State:NC
Practice Address - Zip Code:28363-8522
Practice Address - Country:US
Practice Address - Phone:910-557-3207
Practice Address - Fax:910-557-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-077-048320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities