Provider Demographics
NPI:1497014476
Name:TRILLIUM PALLIATIVE SERVICES
Entity type:Organization
Organization Name:TRILLIUM PALLIATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-235-5015
Mailing Address - Street 1:2100 RAYBROOK ST SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5782
Mailing Address - Country:US
Mailing Address - Phone:616-235-5100
Mailing Address - Fax:
Practice Address - Street 1:2100 RAYBROOK ST SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5782
Practice Address - Country:US
Practice Address - Phone:616-235-5101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAITH HOSPICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-10
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5420Medicare PIN