MEDICARE: GRANITE HEALTHCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1336902261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANITE HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	275 S MAIN ST STE 105
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-6461
Country	:	US
Telephone Number	:	303-357-5631
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 S MAIN ST STE 105
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-6461
Country	:	US
Telephone Number	:	303-357-5631
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	AMBER TUELLER
Credential	:
Telephone Number	:	208-207-2726

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	03/18/2026

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