1326218637 NPI number — TRILLIUM FAMILY SOLUTIONS

Table of Contents

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".




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