National Provider Identifier Database

MEMORY LANE INC
Assisted Living Facility

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.


Contact Information

MEMORY LANE, INC.
1012 FAYETTEVILLE RD
VAN BUREN, AR72956-3471
Phone: 479-474-7223
Fax: 479-474-3444
Website:
Specialty Taxonomy Code
* Assisted Living Facility 310400000X
Alzheimer Center /Dementia Center/Dementia Special Care Unit 311500000X

* Indicates primary specialty

NPI Profile & details for MEMORY LANE, INC.

NPI Number 1598149411
Legal business name
LBN
MEMORY LANE, INC.
Authorized official DEBRA JOHNSON - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 07/10/2015
Last updated 07/10/2015 - About 11 years ago
Sole proprietor1 Not specified
Identifiers
  • AR License #: 101
  • AR Other: 101 ASSISTED LIVING LEVEL II

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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