Healthcare Provider Details

I. General information

NPI: 1912203415
Provider Name (Legal Business Name): GRANITE STATE INDEPENDENT LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 03/28/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CHENELL DR
CONCORD NH
03301-8539
US

IV. Provider business mailing address

21 CHENELL DR
CONCORD NH
03301-8539
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-9680
  • Fax: 603-225-3304
Mailing address:
  • Phone: 603-228-9680
  • Fax: 603-225-3304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNH

VIII. Authorized Official

Name: MS. DEBORAH RITCEY
Title or Position: CEO
Credential:
Phone: 603-410-6507