Organization
GRANVERA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK LEE MD (MEDICAL DIRECTOR/CO-OWNER)
(904) 704-1853
Entity
Organization
Contact information
Practice address
50 WILLOW ST STE 7, MANCHESTER, NH 03103-6322
(904) 704-1853
Mailing address
4 COBBLER LN, BEDFORD, NH 03110-6100
(904) 704-1853
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
251E00000X
Home Health Agency
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
02/19/2025
Last updated
02/19/2025
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