Healthcare Provider Details

I. General information

NPI: 1740975986
Provider Name (Legal Business Name): ATRIA HOLDING CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16379 E PRESERVE LOOP UNIT 2139
CHINO CA
91708-9407
US

IV. Provider business mailing address

16379 E PRESERVE LOOP UNIT 2139
CHINO CA
91708-9407
US

V. Phone/Fax

Practice location:
  • Phone: 909-664-4279
  • Fax:
Mailing address:
  • Phone: 909-664-4279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN GONZALES
Title or Position: CEO
Credential:
Phone: 888-404-9005