Provider Demographics
NPI:1689993602
Name:TRINITEAM, INC.
Entity type:Organization
Organization Name:TRINITEAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PEITZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-836-8106
Mailing Address - Street 1:202 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3632
Mailing Address - Country:US
Mailing Address - Phone:715-836-8106
Mailing Address - Fax:715-836-8104
Practice Address - Street 1:202 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3632
Practice Address - Country:US
Practice Address - Phone:715-836-8106
Practice Address - Fax:715-836-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
WI1936261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1689993602Medicaid