Organization
MEMORY LANE ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABDIASIS HIRSI (DIRECTOR)
(612) 298-0555
Entity
Organization
Contact information
Practice address
15117 EMORY CIR, APPLE VALLEY, MN 55124-1808
(612) 298-0555
Mailing address
15117 EMORY CIR, APPLE VALLEY, MN 55124-1808
(612) 298-0555
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
310400000X
Assisted Living Facility
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
02/15/2025
Last updated
02/15/2025
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