Provider Demographics
NPI:1861496358
Name:TRILLIUM HEALTH, INC
Entity Type:Organization
Organization Name:TRILLIUM HEALTH, INC
Other - Org Name:COMMUNITY HEALTH NETWORK INC, FORMER D/B/A AIDS COMMUNITY HEALTH CENTE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-210-4103
Mailing Address - Street 1:259 MONROE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-3632
Mailing Address - Country:US
Mailing Address - Phone:585-545-7200
Mailing Address - Fax:585-244-6456
Practice Address - Street 1:259 MONROE AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-3632
Practice Address - Country:US
Practice Address - Phone:585-545-7200
Practice Address - Fax:585-244-6456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01230991Medicaid
NY01230991Medicaid