Organization
MEMORY LANE OF DEXTER, LLC
Active
Other names
Memory Lane of Dexter
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN P SELLS (CEO)
(573) 614-7472
Entity
Organization
Contact information
Practice address
415 S CATALPA ST, DEXTER, MO 63841-2017
(573) 624-7491
(573) 624-2061
Mailing address
415 S CATALPA ST, DEXTER, MO 63841-2017
(573) 624-7491
(573) 624-2061
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101456309
—
MO
Enumeration date
08/17/2016
Last updated
04/13/2023
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