Provider Demographics
NPI:1164425583
Name:GRANITE VNA, INC.
Entity Type:Organization
Organization Name:GRANITE VNA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:MDM
Authorized Official - Phone:603-224-4093
Mailing Address - Street 1:30 PILLSBURY ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3502
Mailing Address - Country:US
Mailing Address - Phone:603-224-4093
Mailing Address - Fax:603-230-5687
Practice Address - Street 1:30 PILLSBURY ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3502
Practice Address - Country:US
Practice Address - Phone:603-224-4093
Practice Address - Fax:603-227-7522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03500251E00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80307000Medicaid
NH3076425Medicaid
NH99591029Medicaid
NH3850602Medicaid
NH3073973Medicaid
NH301500Medicare Oscar/Certification
NH3076425Medicaid