Provider Demographics
NPI:1790100915
Name:MEMORY CARE MANAGEMENT, L.C.
Entity Type:Organization
Organization Name:MEMORY CARE MANAGEMENT, L.C.
Other - Org Name:LUVIDA MEMORY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-519-5801
Mailing Address - Street 1:304 E CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-4843
Mailing Address - Country:US
Mailing Address - Phone:254-519-5804
Mailing Address - Fax:254-519-5822
Practice Address - Street 1:2400 PIAZZA DR
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-4445
Practice Address - Country:US
Practice Address - Phone:254-415-7609
Practice Address - Fax:888-389-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)