MEMORY LANE INC. NPI 1598149411

NPI Information

NPI: 1598149411
Provider Name: MEMORY LANE, INC.
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
1012 FAYETTEVILLE RD
VAN BUREN, AR
ZIP 72956
Phone: (479) 474-7223
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MEMORY LANE, INC. is an assisted living facility in Van Buren, AR. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. MEMORY LANE, INC. NPI is 1598149411. The provider is registered as an organization entity type.

The provider's business location address is:

1012 FAYETTEVILLE RD
VAN BUREN, AR
ZIP 72956-471
Phone: (479) 474-7223
Fax: (479) 474-3444

The provider's authorized official is Debra Jean Johnson .
The authorized official title is Executive Director and has the following contact phone number (479) 474-7223.

The enumeration date for this NPI number is 7/10/2015 and was last updated on 7/10/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	311500000X	Alzheimer Center (Dementia Center)		101	ARKANSAS	No
2	310400000X	Assisted Living Facility		101	ARKANSAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	101	OTHER	ARKANSAS	ASSISTED LIVING LEVEL II

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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