Provider Demographics
NPI:1336862614
Name:THE GRANITE STATE CHILDREN'S ALLIANCE
Entity Type:Organization
Organization Name:THE GRANITE STATE CHILDREN'S ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-864-0215
Mailing Address - Street 1:72 S RIVER RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6759
Mailing Address - Country:US
Mailing Address - Phone:603-864-0215
Mailing Address - Fax:
Practice Address - Street 1:25 SUNDIAL AVE STE 315
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-7244
Practice Address - Country:US
Practice Address - Phone:603-623-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)