Provider Demographics
NPI:1568663300
Name:TRILLIUM FAMILY SERVICES
Entity Type:Organization
Organization Name:TRILLIUM FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD TREATMENT TEAM LEADER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:NEWELL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:541-758-7734
Mailing Address - Street 1:4140 NE HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9639
Mailing Address - Country:US
Mailing Address - Phone:541-905-9500
Mailing Address - Fax:
Practice Address - Street 1:4140 NE HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-9639
Practice Address - Country:US
Practice Address - Phone:541-905-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children