Healthcare Provider Details

I. General information

NPI: 1356578611
Provider Name (Legal Business Name): GRANITE CITY HOUSING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HILL ST
BARRE VT
05641-3915
US

IV. Provider business mailing address

120 HILL ST
BARRE VT
05641-3915
US

V. Phone/Fax

Practice location:
  • Phone: 802-476-3283
  • Fax:
Mailing address:
  • Phone: 802-476-3283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. HARRIET DAVIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 802-476-3283