Provider Demographics
NPI:1073264693
Name:ATRIUM VICTORIA HOME, INC
Entity Type:Organization
Organization Name:ATRIUM VICTORIA HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:DATLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-305-3484
Mailing Address - Street 1:14920 OLD COLUMBIA PIKE
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1610
Mailing Address - Country:US
Mailing Address - Phone:240-305-3484
Mailing Address - Fax:301-476-7544
Practice Address - Street 1:9704 INAUGURAL WAY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3157
Practice Address - Country:US
Practice Address - Phone:301-963-8434
Practice Address - Fax:301-963-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness