Memory Lane, Inc.

NPI #1598149411 in Van Buren, Arkansas

Provider Information

NPI Number: 1598149411
Entity Type: Organization
Organization Name: Memory Lane, Inc.
Primary Specialty: Assisted Living Facility
Enumeration Date: Jul 10, 2015
Last Updated: Jul 10, 2015

Practice Location

Address: 1012 FAYETTEVILLE RD
City: Van Buren
State: Arkansas
ZIP Code: 72956-3471
Phone: (479) 474-7223

Authorized Official

Name: DEBRA JEAN JOHNSON
Title: EXECUTIVE DIRECTOR
Phone: (479) 474-7223

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Alzheimer Center (Dementia Center)	311500000X
Assisted Living Facility	310400000X	Primary

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