Healthcare Provider Details

I. General information

NPI: 1083590467
Provider Name (Legal Business Name): BEDROCK COLIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 DIXIEANNE AVE
SACRAMENTO CA
95815-3121
US

IV. Provider business mailing address

2314 MEADOWBROOK DR
LODI CA
95242-4711
US

V. Phone/Fax

Practice location:
  • Phone: 209-663-5776
  • Fax:
Mailing address:
  • Phone: 209-663-5776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MANREET S ATWAL
Title or Position: FOUNDER
Credential:
Phone: 209-663-5776