Provider Demographics
NPI:1053706564
Name:ATIC LLC
Entity type:Organization
Organization Name:ATIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:972-816-7861
Mailing Address - Street 1:4041 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:HEARTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8402
Mailing Address - Country:US
Mailing Address - Phone:972-816-7861
Mailing Address - Fax:
Practice Address - Street 1:4041 EAGLE DR
Practice Address - Street 2:
Practice Address - City:HEARTLAND
Practice Address - State:TX
Practice Address - Zip Code:75126-8402
Practice Address - Country:US
Practice Address - Phone:972-816-7861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services