Provider Demographics
NPI:1972058329
Name:MEDERI FOUNDATION
Entity Type:Organization
Organization Name:MEDERI FOUNDATION
Other - Org Name:MEDERI CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:YANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-488-0210
Mailing Address - Street 1:478 RUSSELL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-7337
Mailing Address - Country:US
Mailing Address - Phone:541-488-0210
Mailing Address - Fax:541-488-6949
Practice Address - Street 1:478 RUSSELL ST STE 101
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-7337
Practice Address - Country:US
Practice Address - Phone:541-488-3133
Practice Address - Fax:541-488-6949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDERI FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-15
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBL-004682261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center