Basic Information
| Provider Information | |||||||||
| NPI: | 1811198021 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRILLIUM FAMILY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13690 SE 120TH WAY | ||||||||
| Address2: | |||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970158693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036986373 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3415 SE POWELL BLVD | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972023371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032349591 | ||||||||
| FaxNumber: | 5032053554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LLOYD | ||||||||
| AuthorizedOfficialFirstName: | KELLI | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING AND REVENUE ASSURANCE MNGR | ||||||||
| AuthorizedOfficialTelephone: | 5032349591 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 323P00000X | OR | Y | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
No ID Information.