Provider Demographics
NPI:1578774782
Name:TRILLIUM FAMILY SERVICES
Entity Type:Organization
Organization Name:TRILLIUM FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CATS 2
Authorized Official - Prefix:
Authorized Official - First Name:DEWAYNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SNOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-758-5944
Mailing Address - Street 1:1220 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1220 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9421
Practice Address - Country:US
Practice Address - Phone:541-409-6812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility