Provider Demographics
NPI:1740941533
Name:TRILLIUM FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:TRILLIUM FAMILY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZY
Authorized Official - Middle Name:
Authorized Official - Last Name:VENZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-205-4362
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:503-234-9591
Mailing Address - Fax:
Practice Address - Street 1:3601 W 10TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-4377
Practice Address - Country:US
Practice Address - Phone:503-234-9591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILLIUM FAMILY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-04
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500828840Medicaid