Organization
GRANITE BAY CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KASAI MUMPINI MBA (PRESIDENT & CEO)
(603) 224-0044
Entity
Organization
Contact information
Practice address
1037 FOREST AVE, PORTLAND, ME 04103-3396
(207) 878-3229
(207) 797-3018
Mailing address
5 WARREN ST, CONCORD, NH 03301-4044
(603) 224-0044
(603) 225-1175
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
417080000
—
ME
Enumeration date
12/27/2006
Last updated
07/22/2009
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