Organization Name: | ATTIC CORRECTIONAL SERVICES INC. |
NPI Number: | 1013052299 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK E WAKEFIELD (DEVELOPMENT & QUALITY ASSURANCE OFF) |
Mailing Address: | 720 W Washington St Appleton |
State: | WI US |
Postal Code: | 549143805 |
Phone Number: | 9208301750 |
Fax Number: | 9208301770 |
NPI Enumeration Date: | 02/21/2007 |
NPI Last Update Date: | 09/11/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | 2608 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |