MEDICARE: ATIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency		TX

General Provider Information

NPI Number	:	1053706564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATIC LLC

Provider Business Mailing Address
First Line	:	4041 EAGLE DR
Second Line	:
City	:	HEARTLAND
State	:	TX
Zip	:	75126-8402
Country	:	US
Telephone Number	:	972-816-7861
Fax Number	:

Provider Business Practice Location Address
First Line	:	4041 EAGLE DR
Second Line	:
City	:	HEARTLAND
State	:	TX
Zip	:	75126-8402
Country	:	US
Telephone Number	:	972-816-7861
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LETICIA C GREEN
Credential	:	B.S.
Telephone Number	:	972-816-7861

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	04/01/2015

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Directions to “ATIC LLC ” Practice Location

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