Provider Demographics
NPI:1659415073
Name:ATREVA HEALTH CARE, INC.
Entity Type:Organization
Organization Name:ATREVA HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:TRILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-524-2121
Mailing Address - Street 1:770 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2706
Mailing Address - Country:US
Mailing Address - Phone:617-524-2121
Mailing Address - Fax:617-524-3810
Practice Address - Street 1:770 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2706
Practice Address - Country:US
Practice Address - Phone:617-524-2121
Practice Address - Fax:617-524-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9712836Medicaid
MAM21144Medicare ID - Type Unspecified