Provider Demographics
NPI:1053926568
Name:TRILLIUM FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:TRILLIUM FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. MANAGER OF BILLING SERVICES
Authorized Official - Prefix:MRS
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 1:2480 NE TWIN KNOLLS DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6833
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:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORNONEMedicaid