Healthcare Provider Details

I. General information

NPI: 1275043770
Provider Name (Legal Business Name): GRANITE RIDGE HOME HEALTH NURSING CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 FULTON ST STE 714
FRESNO CA
93721-2513
US

IV. Provider business mailing address

1060 FULTON ST STE 714
FRESNO CA
93721-2513
US

V. Phone/Fax

Practice location:
  • Phone: 559-977-3952
  • Fax: 559-420-0310
Mailing address:
  • Phone: 559-977-3952
  • Fax: 559-420-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number789398
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number789398
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number789398
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: FRANK KELLY
Title or Position: ASSISTANT ADMINISTRATOR
Credential: RN
Phone: 209-617-9625