Healthcare Provider Details

I. General information

NPI: 1649523655
Provider Name (Legal Business Name): GRANITE STRATEGIC TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NASHUA ROAD 26
LONDONDERRY NH
03053
US

IV. Provider business mailing address

1 NASHUA ROAD 26
LONDONDERRY NH
03053
US

V. Phone/Fax

Practice location:
  • Phone: 603-432-7800
  • Fax:
Mailing address:
  • Phone: 603-432-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: RICHARD JOHN AVILA
Title or Position: MANAGER
Credential:
Phone: 603-432-7800