Healthcare Provider Details

I. General information

NPI: 1275115578
Provider Name (Legal Business Name): LASTING MEMORIES ADULTS CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 CUPP DR
ARKADELPHIA AR
71923-3905
US

IV. Provider business mailing address

1404 ROBINHOOD ST
HOPE AR
71801-7513
US

V. Phone/Fax

Practice location:
  • Phone: 903-559-7171
  • Fax:
Mailing address:
  • Phone: 903-293-7093
  • Fax: 844-878-9982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: KATINA LEVINGSTON
Title or Position: MANAGER
Credential:
Phone: 903-293-7093