MEDICARE: FERN GARDENS MEMORY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311500000X	Alzheimer Center (Dementia Center)

General Provider Information

NPI Number	:	1780471326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERN GARDENS MEMORY CARE LLC

Provider Business Mailing Address
First Line	:	2636 TABLE ROCK RD
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-1525
Country	:	US
Telephone Number	:	541-779-3368
Fax Number	:	541-500-3021

Provider Business Practice Location Address
First Line	:	2636 TABLE ROCK RD
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-1525
Country	:	US
Telephone Number	:	541-779-3368
Fax Number	:	541-500-3021

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JENNIFER LYNN BRODBECK
Credential	:
Telephone Number	:	419-789-1181

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	04/24/2025

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