Healthcare Provider Details

I. General information

NPI: 1689585903
Provider Name (Legal Business Name): LASTING MEMORIES CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15240 N 142ND AVE UNIT 1139
SURPRISE AZ
85379-8762
US

IV. Provider business mailing address

15240 N 142ND AVE UNIT 1139
SURPRISE AZ
85379-8762
US

V. Phone/Fax

Practice location:
  • Phone: 623-260-8689
  • Fax:
Mailing address:
  • Phone: 623-260-8689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LACOTTA HOSKINS-BERRY
Title or Position: OWNER
Credential:
Phone: 623-260-8689