Basic Information
| Provider Information | |||||||||
| NPI: | 1982032405 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRELLIS SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 CLIPPER MILL RD STE 330 | ||||||||
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| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212111995 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 14550 YORK RD | ||||||||
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| City: | SPARKS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211529307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107853845 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2013 | ||||||||
| LastUpdateDate: | 11/06/2014 | ||||||||
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| AuthorizedOfficialLastName: | MALONEY | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4103690000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 103K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.