Healthcare Provider Details

I. General information

NPI: 1750163887
Provider Name (Legal Business Name): GRANITE MUNICIPAL MANUFACURING & SALES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 OLD WALPOLE RD
SURRY NH
03431-8015
US

IV. Provider business mailing address

674 OLD WALPOLE RD
SURRY NH
03431-8015
US

V. Phone/Fax

Practice location:
  • Phone: 239-333-5902
  • Fax:
Mailing address:
  • Phone: 239-333-5902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JOHN TRAHAN
Title or Position: OWNER/CONTRACTOR
Credential:
Phone: 239-333-5902