1861496358 NPI number — TRILLIUM HEALTH, INC

Table of content: (NPI 1861496358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861496358 NPI number — TRILLIUM HEALTH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRILLIUM HEALTH, INC
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:
COMMUNITY HEALTH NETWORK INC, FORMER D/B/A AIDS COMMUNITY HEALTH CENTE
Provider Other Organization Name Type Code:
4
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:
1861496358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
259 MONROE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14607-3632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-545-7200
Provider Business Mailing Address Fax Number:
585-244-6456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
259 MONROE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14607-3632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-545-7200
Provider Business Practice Location Address Fax Number:
585-244-6456
Provider Enumeration Date:
06/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DEMEO
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
585-210-4103

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01230991 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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