Provider Demographics
NPI:1912203415
Name:GRANITE STATE INDEPENDENT LIVING
Entity Type:Organization
Organization Name:GRANITE STATE INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RITCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-410-6507
Mailing Address - Street 1:21 CHENELL DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-8539
Mailing Address - Country:US
Mailing Address - Phone:603-228-9680
Mailing Address - Fax:603-225-3304
Practice Address - Street 1:21 CHENELL DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-8539
Practice Address - Country:US
Practice Address - Phone:603-228-9680
Practice Address - Fax:603-225-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH026000618Medicaid