Provider Demographics
NPI:1710144209
Name:TRI MANAGEMENT
Entity Type:Organization
Organization Name:TRI MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:THOEN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:208-232-4333
Mailing Address - Street 1:357 W CENTER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3236
Mailing Address - Country:US
Mailing Address - Phone:208-232-4333
Mailing Address - Fax:208-232-1777
Practice Address - Street 1:357 W CENTER ST STE 201
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3236
Practice Address - Country:US
Practice Address - Phone:208-232-4333
Practice Address - Fax:208-232-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807456601Medicaid
ID807456600Medicaid