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General NPI Number Information
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NPI Number | 1447160585
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Entity Type | Organization
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Legal Business Name | GRANITE RIDGE RECOVERY LLC
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 53 FALLS AVE
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City | GILFORD
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State | NH
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Zip | 03249-7421
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Country | US
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Telephone | 661-621-5859
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Fax |
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Provider Business Mailing Address
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Address Line | 53 FALLS AVE
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City | GILFORD
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State | NH
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Zip | 03249-7421
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Country | US
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Telephone | 661-621-5859
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | ADAM MARTIN MOULTON
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Credential | CDAC
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Telephone | 603-832-1913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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