Provider Demographics
NPI:1851908487
Name:TRILLIUM COMMUNITY HEALTH PLAN, INC.
Entity type:Organization
Organization Name:TRILLIUM COMMUNITY HEALTH PLAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, ASSOCIATE GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHOREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-720-5567
Mailing Address - Street 1:7700 FORSYTH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13221 SW 68TH PKWY STE 300
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8328
Practice Address - Country:US
Practice Address - Phone:877-600-5472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization