Organization
MEMORY LANE HOME HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA HEDGES (ADMINISTRATOR)
(540) 779-0529
Entity
Organization
Contact information
Practice address
1300 THORNTON ST STE 102, FREDERICKSBURG, VA 22401-4654
(540) 779-0529
(530) 779-0529
Mailing address
1300 THORNTON ST STE 102, FREDERICKSBURG, VA 22401-4654
(540) 779-0529
(530) 779-0529
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCO-2038
HOME CARE ORGANIZATION
VA
Enumeration date
01/29/2019
Last updated
01/29/2019
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