Active NPI
Trivium Life Services
- Developmentally Disabled Services Day Training Agency
- Council Bluffs, IA
National Provider Identifier
1841327673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmentally Disabled Services Day Training Agency
- Legal business name
- TRIVIUM LIFE SERVICES
- Practice address
- 1851 Madison Ave Ste 718
Council Bluffs, IA 51503-3602 - Phone
- (712) 256-7888
- Fax
- (712) 256-6502
- NPI assigned
- Feb 28, 2007
- Last updated
- Dec 10, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Alex Walker
- Title
- VP Information Technology
- Phone
- (712) 256-7888
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmentally Disabled Services Day Training Agency | 251C00000X | Primary | ||
| Adult Day Care Clinic/Center | 261QA0600X | |||
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | |||
| Mental Illness Community Based Residential Treatment Facility | 320800000X | |||
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X |
Addresses
Primary practice location
1851 Madison Ave Ste 718
Council Bluffs, IA 51503-3602
Mailing address
1851 Madison Ave Ste 718
Council Bluffs, IA 51503-3602
Phone (712) 256-7888
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0761718 | Medicaid | IA | |
| 0106476 | Medicaid | IA | |
| 0239913 | Medicaid | IA |
Other names 1
- Crossroads of Western Iowa
National Provider Directory
National Provider Directory- Tax ID family
- Trivium Life Services
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Sioux City, IA
- NPI 1235711672
Locations
1 Crossroads Pl
Missouri Valley, IA 51555
Ownership & related parties
Subparts reporting this organization as parent 1
Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Sioux City, IA
- NPI 1235711672
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Mental Health Counselor
- Omaha, NE
- NPI 1699187674
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1733788800000",
"number": "1841327673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1851 MADISON AVE STE 718",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515033602",
"telephone_number": "712-256-7888",
"fax_number": "712-256-6502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1851 MADISON AVE STE 718",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515033602",
"telephone_number": "712-256-7888",
"fax_number": "712-256-6502"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRIVIUM LIFE SERVICES",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-28",
"last_updated": "2024-12-10",
"certification_date": "2024-12-10",
"status": "A",
"authorized_official_last_name": "WALKER",
"authorized_official_first_name": "ALEX",
"authorized_official_title_or_position": "VP INFORMATION TECHNOLOGY",
"authorized_official_telephone_number": "712-256-7888"
},
"taxonomies": [
{
"code": "251C00000X",
"taxonomy_group": "",
"desc": "Day Training, Developmentally Disabled Services",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QA0600X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adult Day Care",
"state": null,
"license": null,
"primary": false
},
{
"code": "320600000X",
"taxonomy_group": "",
"desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": null,
"license": null,
"primary": false
},
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": null,
"license": null,
"primary": false
},
{
"code": "320900000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0761718",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0106476",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0239913",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Crossroads of Western Iowa",
"code": "4",
"type": "Former Legal Business Name"
}
]
}Other providers in Council Bluffs, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.