| Grace Haven House | |
|
6111 Magazine Dr Mechanicsville VA 23111-4540 | |
| (804) 779-2356 | |
| (804) 779-7566 |
| Full Name | Grace Haven House |
|---|---|
| Speciality | Counselor |
| Location | 6111 Magazine Dr, Mechanicsville, Virginia |
| Authorized Official Name and Position | Karlyn Clevert Smith (CAO/PROGRAM DIRECTOR) |
| Authorized Official Contact | 8047792356 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Haven House Po Box 2012 Mechanicsville VA 23116-0010 Ph: (804) 779-2356 | Grace Haven House 6111 Magazine Dr Mechanicsville VA 23111-4540 Ph: (804) 779-2356 |
| NPI Number | 1134130909 |
|---|---|
| Provider Enumeration Date | 08/10/2006 |
| Last Update Date | 09/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134130909 | NPI | - | NPPES |
| 010217245 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | SS-269-06 (Virginia) | Secondary |
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