1275043770 NPI number — GRANITE RIDGE HOME HEALTH NURSING CARE, INC.

Table of content: (NPI 1275043770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275043770 NPI number — GRANITE RIDGE HOME HEALTH NURSING CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRANITE RIDGE HOME HEALTH NURSING CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GRANITE RIDGE HOME HEALTH CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275043770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35300 HIGHWAY 41 STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COARSEGOLD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93614-8717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-977-3952
Provider Business Mailing Address Fax Number:
559-420-0310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35300 HIGHWAY 41 STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COARSEGOLD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93614-8717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-977-3952
Provider Business Practice Location Address Fax Number:
559-420-0310
Provider Enumeration Date:
10/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KELLY
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO, PRESIDENT
Authorized Official Telephone Number:
559-977-3952

Provider Taxonomy Codes

  • Taxonomy code: 163WE0003X , with the licence number:  789398 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WH1000X , with the licence number: 789398 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WI0500X , with the licence number: 789398 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1275043770 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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