Provider Demographics
NPI:1780471326
Name:FERN GARDENS MEMORY CARE LLC
Entity type:Organization
Organization Name:FERN GARDENS MEMORY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BRODBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-789-1181
Mailing Address - Street 1:2636 TABLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-1525
Mailing Address - Country:US
Mailing Address - Phone:541-779-3368
Mailing Address - Fax:541-500-3021
Practice Address - Street 1:2636 TABLE ROCK RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-1525
Practice Address - Country:US
Practice Address - Phone:541-779-3368
Practice Address - Fax:541-500-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)