Provider Demographics
NPI:1235711672
Name:TRIVIUM LIFE SERVICES
Entity Type:Organization
Organization Name:TRIVIUM LIFE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DARIAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:ZIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-256-7888
Mailing Address - Street 1:1851 MADISON AVE STE 718
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-3602
Mailing Address - Country:US
Mailing Address - Phone:712-256-7888
Mailing Address - Fax:712-256-6502
Practice Address - Street 1:835 GORDON DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1829
Practice Address - Country:US
Practice Address - Phone:712-522-3346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIVIUM LIFE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health