Provider Demographics
NPI:1760832505
Name:GRANITE PATHWAYS
Entity type:Organization
Organization Name:GRANITE PATHWAYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-525-9203
Mailing Address - Street 1:633 3RD AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6733
Mailing Address - Country:US
Mailing Address - Phone:817-542-1988
Mailing Address - Fax:866-834-4570
Practice Address - Street 1:115 HERITAGE AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5610
Practice Address - Country:US
Practice Address - Phone:877-369-0928
Practice Address - Fax:603-570-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health