Provider Demographics
NPI:1447845763
Name:ELDERLY AND DISABLED SERVICES
Entity type:Organization
Organization Name:ELDERLY AND DISABLED SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCPHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-261-1991
Mailing Address - Street 1:3126 STATE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8665
Mailing Address - Country:US
Mailing Address - Phone:458-225-9358
Mailing Address - Fax:541-631-3424
Practice Address - Street 1:4439 HAMRICK RD
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2816
Practice Address - Country:US
Practice Address - Phone:541-261-1991
Practice Address - Fax:541-631-3424
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELDERLY AND DISABLED SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-08
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500791695Medicaid