Provider Demographics
NPI:1437844420
Name:ATTIC CORRECTIONAL SERVICES, INC.
Entity Type:Organization
Organization Name:ATTIC CORRECTIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:YEAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-571-4077
Mailing Address - Street 1:2670 UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5852
Mailing Address - Country:US
Mailing Address - Phone:920-469-2569
Mailing Address - Fax:920-469-2580
Practice Address - Street 1:2670 UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5852
Practice Address - Country:US
Practice Address - Phone:920-469-2569
Practice Address - Fax:920-469-2580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATTIC CORRECTIONAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility