Provider Demographics
NPI:1952048977
Name:FERNREACH, LLC.
Entity Type:Organization
Organization Name:FERNREACH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-915-2690
Mailing Address - Street 1:314 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2315
Mailing Address - Country:US
Mailing Address - Phone:541-915-2690
Mailing Address - Fax:541-228-9370
Practice Address - Street 1:304 S 13TH ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2315
Practice Address - Country:US
Practice Address - Phone:458-201-4911
Practice Address - Fax:541-228-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR019047Medicaid
OR500660349OtherDMAP