Provider Demographics
NPI:1275115578
Name:LASTING MEMORIES ADULTS CARE HOME LLC
Entity Type:Organization
Organization Name:LASTING MEMORIES ADULTS CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-293-7093
Mailing Address - Street 1:1404 ROBINHOOD ST
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-7513
Mailing Address - Country:US
Mailing Address - Phone:903-293-7093
Mailing Address - Fax:844-878-9982
Practice Address - Street 1:806 CUPP DR
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-3905
Practice Address - Country:US
Practice Address - Phone:903-559-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility