Provider Demographics
NPI:1659066637
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 1:2 BRIGHTON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915
Mailing Address - Country:US
Mailing Address - Phone:920-364-9335
Mailing Address - Fax:920-840-6445
Practice Address - Street 1:2 BRIGHTON CIRCLE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915
Practice Address - Country:US
Practice Address - Phone:920-364-9335
Practice Address - Fax:920-840-6445
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