Healthcare Provider Details

I. General information

NPI: 1194646430
Provider Name (Legal Business Name): GRANITE COMMUNITY LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 SOMERVILLE ST FL 1
MANCHESTER NH
03103-4531
US

IV. Provider business mailing address

591 SOMERVILLE ST FL 1
MANCHESTER NH
03103-4531
US

V. Phone/Fax

Practice location:
  • Phone: 617-420-3111
  • Fax: 617-865-8060
Mailing address:
  • Phone: 617-420-3111
  • Fax: 617-865-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. AMIN ABDI
Title or Position: FOUNDER & ADMINISTRATOR
Credential:
Phone: 617-420-3111