Provider Demographics
NPI:1053856690
Name:GRANITE CASE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:GRANITE CASE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VIRTUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-848-7345
Mailing Address - Street 1:288 BAPTIST HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANTERBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03224-2506
Mailing Address - Country:US
Mailing Address - Phone:603-848-7345
Mailing Address - Fax:
Practice Address - Street 1:288 BAPTIST HILL RD
Practice Address - Street 2:
Practice Address - City:CANTERBURY
Practice Address - State:NH
Practice Address - Zip Code:03224-2506
Practice Address - Country:US
Practice Address - Phone:603-848-7345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03221251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH03221Medicaid