Organization
TEAM DISCOERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURENCE TRIMBLE (ADMINISTRATOR)
(414) 467-2255
Entity
Organization
Contact information
Practice address
2178 N 74TH ST, WAUWATOSA, WI 53213-1702
(414) 467-2255
(262) 252-4214
Mailing address
W130N6650 NORTHFIELD DR, MENOMONEE FALLS, WI 53051-0515
(414) 467-2255
(262) 252-4214
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
12606
WI
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
12617
WI
Other
Enumeration date
01/20/2009
Last updated
01/20/2009
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