Healthcare Provider Details

I. General information

NPI: 1598427502
Provider Name (Legal Business Name): GRANITE HOUSE OF HELP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 11/13/2021
Certification Date: 11/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 VALLEY ST STE 4
MANCHESTER NH
03103-3532
US

IV. Provider business mailing address

84 KARATZAS AVE APT 203
MANCHESTER NH
03104-4851
US

V. Phone/Fax

Practice location:
  • Phone: 603-760-8715
  • Fax:
Mailing address:
  • Phone: 603-760-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CRISPIN MILELE
Title or Position: ADMINISTRATOR
Credential:
Phone: 603-760-8715