Provider Demographics
NPI:1376175976
Name:THE GRANITE HOUSE SOBER LIVING, LLC
Entity Type:Organization
Organization Name:THE GRANITE HOUSE SOBER LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUATTROCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-328-8601
Mailing Address - Street 1:6 MANOR PKWY
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2841
Mailing Address - Country:US
Mailing Address - Phone:603-328-8601
Mailing Address - Fax:
Practice Address - Street 1:35 W BROADWAY
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2375
Practice Address - Country:US
Practice Address - Phone:603-328-8601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH04710OtherLICENSE TO OPERATE - SUBSTANCE USE DISORDER RES TREATMENT