# TEAM DISCOERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184861635
- **Authorized official:** LAURENCE TRIMBLE (ADMINISTRATOR)
- **Authorized official phone:** (414) 467-2255

## Contact information

- **Practice address:** 2178 N 74TH ST, WAUWATOSA, WI 53213-1702
- **Practice address phone:** (414) 467-2255
- **Practice address fax:** (262) 252-4214
- **Mailing address:** W130N6650 NORTHFIELD DR, MENOMONEE FALLS, WI 53051-0515
- **Mailing address phone:** (414) 467-2255
- **Mailing address fax:** (262) 252-4214

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 12606 | WI | Yes |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 12617 | WI | — |

## Other

- **Enumeration date:** 01/20/2009
- **Last updated:** 01/20/2009