Organization
TRIVIUM LIFE SERVICES
Active
Other names
Crossroads of Western Iowa
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX WALKER (VP INFORMATION TECHNOLOGY)
(712) 256-7888
Entity
Organization
Contact information
Practice address
1851 MADISON AVE STE 718, COUNCIL BLUFFS, IA 51503-3602
(712) 256-7888
(712) 256-6502
Mailing address
1851 MADISON AVE STE 718, COUNCIL BLUFFS, IA 51503-3602
(712) 256-7888
(712) 256-6502
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0106476
—
IA
05
—
0239913
—
IA
05
—
0761718
—
IA
Enumeration date
02/28/2007
Last updated
12/10/2024
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