Provider Demographics
NPI:1083590467
Name:BEDROCK COLIVING LLC
Entity type:Organization
Organization Name:BEDROCK COLIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MANREET
Authorized Official - Middle Name:S
Authorized Official - Last Name:ATWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-663-5776
Mailing Address - Street 1:2314 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4711
Mailing Address - Country:US
Mailing Address - Phone:209-663-5776
Mailing Address - Fax:
Practice Address - Street 1:9552 BISMARK PL
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1574
Practice Address - Country:US
Practice Address - Phone:209-663-5776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-12
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage