Provider Demographics
NPI:1578128971
Name:GRANITE HOUSE RCF LLC
Entity Type:Organization
Organization Name:GRANITE HOUSE RCF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-701-4414
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:MO
Mailing Address - Zip Code:63650-0006
Mailing Address - Country:US
Mailing Address - Phone:573-546-7283
Mailing Address - Fax:
Practice Address - Street 1:321 S MAIN ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:MO
Practice Address - Zip Code:63650-1406
Practice Address - Country:US
Practice Address - Phone:573-546-7283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness