Provider Demographics
NPI:1538475918
Name:MEMORY LANE HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:MEMORY LANE HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LETISIA
Authorized Official - Middle Name:MORENO
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-287-2999
Mailing Address - Street 1:1207 JOANN ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6017
Mailing Address - Country:US
Mailing Address - Phone:956-287-2999
Mailing Address - Fax:956-287-2998
Practice Address - Street 1:312 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3302
Practice Address - Country:US
Practice Address - Phone:956-287-2999
Practice Address - Fax:956-287-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care