Organization
MEMORY LANE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY MICHELLE WOMBOLT CDP (OWNER)
(760) 445-3639
Entity
Organization
Contact information
Practice address
1642 LISA AVE, VISTA, CA 92084-3054
(760) 445-3639
Mailing address
1642 LISA AVE, VISTA, CA 92084-3054
(760) 445-3639
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
04/08/2024
Last updated
06/17/2024
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