Provider Demographics
NPI:1811108780
Name:TRILLIUM FAMILY SERVICES
Entity type:Organization
Organization Name:TRILLIUM FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT TEAM LEADER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNAE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:541-758-1121
Mailing Address - Street 1:1730 NW GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-2643
Mailing Address - Country:US
Mailing Address - Phone:541-990-3677
Mailing Address - Fax:
Practice Address - Street 1:4455 NW HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-758-5944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility