Residential Openings

This form generates information in Trillium's Residential Vacancy list and allows Trillium to send out monthly reminders to our providers and partners to update vacancy information. A form should be submitted for each home within your organization for which you would accept a Trillium member. You do not have to be an in-network provider with Trillium to partner with us for residential referrals. Vacancy information is available to all staff within Trillium that may assist a member in locating a residential option based on their level of care needed. Please contact a Residential Services Coordinator at residentialopenings@trilliumnc.org with any questions regarding this form or the vacancy list.

Provider Name*

Provider Contact Name*

Person who will be updating vacancies monthly.

Provider Contact Phone #*

Provider Contact Email*

E-mail address of staff where initial contact should be made for vacancies and who will receive requests for updating vacancies.

Secondary Contact

Secondary Contact E-mail

Secondary Contact Tel#

House Name*

Name of home or facility. If a network provider, please list home as it's listed in the contract.

City*

County*

Select

Catchment Location*

Select whether the home is within Trillium's 26 county catchment area. for complete county list, please refer to the website: https://www.trilliumhealthresources.org/regional-operations

Select

Type of Site

Select

Funding*

Choose all funding types that are accepted for this home.

Select

Gender*

Select

Minimum Age*

Maximum Age*

Vacancies*

Select

Total # Beds

Ambulatory/ Non-Ambulatory

Please choose based on current license (as applicable)

Select

Other Important Information

List any relevant details to member selection, such as: accepts medically fragile members, current members in home, requires school attendance (if a child provider), total # beds, wheelchair accessible, setting of home, awake staff at night, etc.

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