Provider Demographics
NPI:1346752110
Name:ROGUE VALLEY DOULAS, LLC
Entity Type:Organization
Organization Name:ROGUE VALLEY DOULAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA CANJURA
Authorized Official - Suffix:
Authorized Official - Credentials:THW DOULA
Authorized Official - Phone:541-690-8482
Mailing Address - Street 1:PO BOX 4634
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0186
Mailing Address - Country:US
Mailing Address - Phone:541-690-8482
Mailing Address - Fax:541-500-3310
Practice Address - Street 1:3265 BIDDLE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4122
Practice Address - Country:US
Practice Address - Phone:541-690-8482
Practice Address - Fax:541-500-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1790147536Medicaid