Provider Demographics
NPI:1275794638
Name:AAA ATRIUM CLASSIC ASSISTED LIVING, INC.
Entity Type:Organization
Organization Name:AAA ATRIUM CLASSIC ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:DATLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:240-305-3484
Mailing Address - Street 1:2701 MARTELLO DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4534
Mailing Address - Country:US
Mailing Address - Phone:301-879-7608
Mailing Address - Fax:301-476-7544
Practice Address - Street 1:2701 MARTELLO DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4534
Practice Address - Country:US
Practice Address - Phone:301-879-7608
Practice Address - Fax:301-476-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15AL0315310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility