1326218637 NPI number — TRILLIUM FAMILY SOLUTIONS

Table of content: (NPI 1326218637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326218637 NPI number — TRILLIUM FAMILY SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRILLIUM FAMILY SOLUTIONS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326218637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 CLEVELAND AVE NW
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44702-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-454-7066
Provider Business Mailing Address Fax Number:
330-437-0016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 CLEVELAND AVE NW
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44702-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-454-7066
Provider Business Practice Location Address Fax Number:
330-437-0016
Provider Enumeration Date:
03/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FIRESTONE
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
MARCELLA
Authorized Official Title or Position:
VICE PRESIDENT ADMINISTRATION
Authorized Official Telephone Number:
330-454-7066

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2584270 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com