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General NPI Number Information
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NPI Number | 1083590467
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Entity Type | Organization
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Legal Business Name | BEDROCK COLIVING LLC
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 9552 BISMARK PL
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City | STOCKTON
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State | CA
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Zip | 95209-1574
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Country | US
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Telephone | 209-663-5776
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Fax |
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Provider Business Mailing Address
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Address Line | 2314 MEADOWBROOK DR
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City | LODI
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State | CA
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Zip | 95242-4711
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Country | US
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Telephone | 209-663-5776
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MANREET S ATWAL
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Credential |
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Telephone | 209-663-5776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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