Provider Demographics
NPI:1265446496
Name:GRANITE HOUSE, INC
Entity Type:Organization
Organization Name:GRANITE HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:LISTER
Authorized Official - Last Name:GEAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-876-3007
Mailing Address - Street 1:288 E GREEN ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5410
Mailing Address - Country:US
Mailing Address - Phone:410-876-3007
Mailing Address - Fax:410-751-7797
Practice Address - Street 1:288 E GREEN ST
Practice Address - Street 2:PRP
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5410
Practice Address - Country:US
Practice Address - Phone:410-876-3007
Practice Address - Fax:410-751-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation