Provider Demographics
NPI:1093873382
Name:TRILLIUM FAMILY SERVICES
Entity Type:Organization
Organization Name:TRILLIUM FAMILY SERVICES
Other - Org Name:PARRY CENTER FOR CHILDREN
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZY
Authorized Official - Middle Name:K
Authorized Official - Last Name:VENZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-205-4362
Mailing Address - Street 1:3415 SE POWELL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202
Mailing Address - Country:US
Mailing Address - Phone:503-205-4362
Mailing Address - Fax:503-205-0193
Practice Address - Street 1:3415 SE POWELL BOULEVARD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202
Practice Address - Country:US
Practice Address - Phone:503-205-4362
Practice Address - Fax:503-205-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
OR322D00000X, 323P00000X, 385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251S00000XAgenciesCommunity/Behavioral Health
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR312008Medicaid