Provider Demographics
NPI:1306833058
Name:ATTIC ANGEL ASSOCIATION
Entity Type:Organization
Organization Name:ATTIC ANGEL ASSOCIATION
Other - Org Name:ATTIC ANGEL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:608-662-8847
Mailing Address - Street 1:8301 OLD SAUK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-4389
Mailing Address - Country:US
Mailing Address - Phone:608-662-8842
Mailing Address - Fax:608-662-8800
Practice Address - Street 1:8301 OLD SAUK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-4389
Practice Address - Country:US
Practice Address - Phone:608-662-8842
Practice Address - Fax:608-662-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1035314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI52-5644Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER