MEDICARE: ATTIC CORRECTIONAL SERVICES INC.

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	2608	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013052299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATTIC CORRECTIONAL SERVICES INC.

Provider Business Mailing Address
First Line	:	PO BOX 7370
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53707-7370
Country	:	US
Telephone Number	:	608-223-0017
Fax Number	:	608-223-0019

Provider Business Practice Location Address
First Line	:	720 W WASHINGTON ST
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54914-3805
Country	:	US
Telephone Number	:	920-830-1750
Fax Number	:	920-830-1770

Authorized Official
Title or Position	:	DEVELOPMENT & QUALITY ASSURANCE OFF
Name	:	MARK E WAKEFIELD
Credential	:
Telephone Number	:	608-223-0017

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	09/11/2008

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