Provider Demographics
NPI:1437247228
Name:GRANITE CITY HOUSING, INC.
Entity Type:Organization
Organization Name:GRANITE CITY HOUSING, INC.
Other - Org Name:LINCOLN HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HARRIET
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-476-3283
Mailing Address - Street 1:120 HILL ST
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-3915
Mailing Address - Country:US
Mailing Address - Phone:802-476-3283
Mailing Address - Fax:802-476-3349
Practice Address - Street 1:120 HILL ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-3915
Practice Address - Country:US
Practice Address - Phone:802-476-3283
Practice Address - Fax:802-476-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0175311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W122Medicaid