Organization
MEMORY LANE LLC
Active
Organization
MEMORY LANE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY MICHELLE WOMBOLT CDP (OWNER)
(760) 445-3639
Entity
Organization
Contact information
Practice address
1642 LISA AVE, VISTA, CA 92084-3054
(760) 536-3139
(760) 806-3582
Mailing address
1642 LISA AVE, VISTA, CA 92084-3054
(760) 445-3639
(760) 806-3582
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
10/10/2025
Last updated
10/10/2025
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