Provider Demographics
NPI:1467860114
Name:ACUMEN OF WISCONSIN, LLC
Entity Type:Organization
Organization Name:ACUMEN OF WISCONSIN, LLC
Other - Org Name:OUTREACH HEALTH SERVICES OF WISCONSIN, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COMPLIANCE ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATALINIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-295-3328
Mailing Address - Street 1:5416 E BASELINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 3RD AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020
Practice Address - Country:US
Practice Address - Phone:877-901-5826
Practice Address - Fax:800-687-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
WI253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1467860114Medicaid