Provider Demographics
NPI:1922209121
Name:TRILLIUM FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:TRILLIUM FAMILY SERVICES, INC.
Other - Org Name:CHILDREN'S FARM HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING & REVENUE ASSURANCE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-205-3588
Mailing Address - Street 1:3415 SE POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3371
Mailing Address - Country:US
Mailing Address - Phone:503-205-3588
Mailing Address - Fax:503-205-0193
Practice Address - Street 1:4455 NE HWY 20
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-9695
Practice Address - Country:US
Practice Address - Phone:541-757-1852
Practice Address - Fax:503-205-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Not Answered323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR313171Medicaid