Healthcare Provider Details

I. General information

NPI: 1699377119
Provider Name (Legal Business Name): THE GRANITE YMCA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MECHANIC ST
MANCHESTER NH
03101-1923
US

IV. Provider business mailing address

117 MARKET ST
MANCHESTER NH
03101-1933
US

V. Phone/Fax

Practice location:
  • Phone: 603-623-3558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CINDY LAFOND
Title or Position: ASSOCIATION DIRECTOR OF HEALTHY LIV
Credential:
Phone: 603-232-8650