Provider Demographics
NPI:1326268194
Name:GRANITE CARE HOME, INC.
Entity Type:Organization
Organization Name:GRANITE CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DHEIN
Authorized Official - Suffix:
Authorized Official - Credentials:QMRP
Authorized Official - Phone:320-251-4736
Mailing Address - Street 1:202 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1412
Mailing Address - Country:US
Mailing Address - Phone:320-251-4736
Mailing Address - Fax:320-654-6584
Practice Address - Street 1:202 2ND AVE S
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1412
Practice Address - Country:US
Practice Address - Phone:320-251-4736
Practice Address - Fax:320-654-6584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN800919-2-RS315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities