MEDICARE: ATRIA SENIOR LIVING GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1427352376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATRIA SENIOR LIVING GROUP, INC.

Provider Business Mailing Address
First Line	:	5317 NEW COPELAND RD
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-3963
Country	:	US
Telephone Number	:	903-509-9575
Fax Number	:

Provider Business Practice Location Address
First Line	:	5317 NEW COPELAND RD
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-3963
Country	:	US
Telephone Number	:	903-509-9575
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOHN MOORE
Credential	:
Telephone Number	:	502-779-7608

Provider Enumeration Date	:	01/07/2011
Last Update Date	:	01/07/2011

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