Provider Demographics
NPI:1851909741
Name:TRILLIUM HOUSE, INC.
Entity Type:Organization
Organization Name:TRILLIUM HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIR.
Authorized Official - Prefix:MR
Authorized Official - First Name:PAT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-264-5026
Mailing Address - Street 1:1144 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4408
Mailing Address - Country:US
Mailing Address - Phone:906-264-5026
Mailing Address - Fax:906-273-1011
Practice Address - Street 1:1144 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4408
Practice Address - Country:US
Practice Address - Phone:906-264-5026
Practice Address - Fax:906-273-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAM520379519OtherSTATE OF MICHIGAN