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General NPI Number Information
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NPI Number | 1033083209
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Entity Type | Organization
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Legal Business Name | MEMORY LANE AT HOME AGENCY LLC
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 10/05/2025
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Provider Practice Location Address
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Address Line | 254 COURT AVE # 205
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City | MEMPHIS
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State | TN
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Zip | 38103-2361
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Country | US
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Telephone | 901-221-4430
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Fax | 901-207-8860
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Provider Business Mailing Address
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Address Line | 254 COURT AVE # 205
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City | MEMPHIS
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State | TN
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Zip | 38103-2361
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Country | US
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Telephone | 901-221-4430
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Fax | 901-207-8860
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Authorized Official
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Title or Position | OWNER
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Name | TAMARA M CLARK
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Credential |
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Telephone | 901-297-6113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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