Healthcare Provider Details

I. General information

NPI: 1447160585
Provider Name (Legal Business Name): GRANITE RIDGE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 FALLS AVE
GILFORD NH
03249-7421
US

IV. Provider business mailing address

53 FALLS AVE
GILFORD NH
03249-7421
US

V. Phone/Fax

Practice location:
  • Phone: 661-621-5859
  • Fax:
Mailing address:
  • Phone: 661-621-5859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM MARTIN MOULTON
Title or Position: OWNER/OPERATOR
Credential: CDAC
Phone: 603-832-1913