Provider Demographics
NPI:1780137596
Name:MEMORYCO, LLC
Entity type:Organization
Organization Name:MEMORYCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:S
Authorized Official - Last Name:TITIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:650-521-3452
Mailing Address - Street 1:PO BOX 5253
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN CLUB
Mailing Address - State:CA
Mailing Address - Zip Code:93222-5253
Mailing Address - Country:US
Mailing Address - Phone:323-486-3626
Mailing Address - Fax:
Practice Address - Street 1:2248 SAINT BERNARD DRIVE
Practice Address - Street 2:
Practice Address - City:PINE MOUNTAIN CLUB
Practice Address - State:CA
Practice Address - Zip Code:93222
Practice Address - Country:US
Practice Address - Phone:323-486-3626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty