Provider Demographics
NPI:1326218637
Name:TRILLIUM FAMILY SOLUTIONS
Entity Type:Organization
Organization Name:TRILLIUM FAMILY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:MARCELLA
Authorized Official - Last Name:FIRESTONE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:330-454-7066
Mailing Address - Street 1:101 CLEVELAND AVE NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1700
Mailing Address - Country:US
Mailing Address - Phone:330-454-7066
Mailing Address - Fax:330-437-0016
Practice Address - Street 1:101 CLEVELAND AVE NW
Practice Address - Street 2:SUITE 300
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1700
Practice Address - Country:US
Practice Address - Phone:330-454-7066
Practice Address - Fax:330-437-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2584270Medicaid