NPIMap

Organization Active NPI

Memory Lane of Dexter, LLC

Doing business as Memory Lane of Dexter

  • Skilled Nursing Facility
  • Dexter, MO
National Provider Identifier
1366997678
Registry record updated Apr 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MEMORY LANE OF DEXTER, LLC
Doing business as
Memory Lane of Dexter
Practice address
415 S Catalpa St
Dexter, MO 63841-2017
Phone
(573) 624-7491
Fax
(573) 624-2061
NPI assigned
Aug 17, 2016
Last updated
Apr 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Benjamin P Sells
Title
Ceo
Phone
(573) 614-7472

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

415 S Catalpa St
Dexter, MO 63841-2017

Mailing address

415 S Catalpa St
Dexter, MO 63841-2017
Phone (573) 624-7491

Other identifiers 1

IdentifierTypeStateIssuer
101456309MedicaidMO

Other names 1

  • Memory Lane of Dexter Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://pointclickcare.com/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230412001368 MO Part A Provider - Skilled Nursing Facility 0446625081 Practice locations: Dexter, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366997678. Details of each certification follow.

Skilled nursing facility certification: CCN 265382

Legal name
MEMORY LANE OF DEXTER LLC
Doing business as
MEMORY LANE OF DEXTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 1, 1989
Last certification
Jan 17, 2025
Beds
73
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Paradigm Senior Management
Most recent change of ownership
Apr 3, 2023
Organization structure
LLCProprietary
Incorporated
Nov 17, 2022 in MO
Enrollment address
415 S Catalpa St
Dexter, MO 63841-2017
Nursing home name
MEMORY LANE OF DEXTER
Affiliated entity
PARADIGM SENIOR MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Memory Lane of DexterCCN 265382 · All quality measures
Overall star rating
4 of 5
Health inspections
5 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Sep 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7366.1 residents per day on average
Chain
Paradigm Senior Management8 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0442232Memory Lane of Dexter415 S Catalpa Street, Dexter, MO 63841Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Individual Adp of the SNF Apr 3, 2023
Benjamin P Sells Individual 5% Or Greater Direct Ownership InterestCeo Apr 3, 2023 50%
Corporate OfficerPresident/Member Apr 3, 2023 50%
Operational/Managerial ControlPresident/Member Apr 3, 2023 50%
Michelle Chism Individual Operational/Managerial Control Apr 3, 2023
Adp of the SNF Apr 3, 2023
Leslie Noles Individual Operational/Managerial Control Jan 3, 2024
Adp of the SNF Jan 3, 2024
Individual Adp of the SNF Jan 23, 2023
Organization, Dexter, MO LLC, Holding company Adp of the SNF Mar 17, 2025
Angela R Jones Individual 5% Or Greater Direct Ownership InterestMember Apr 3, 2023 50%
Corporate OfficerMember Apr 3, 2023 50%
Alliance Bank Organization, Sikeston, MO Corporation, Financial institution 5% Or Greater Mortgage Interest Jan 23, 2023 100%
Adp of the SNF Mar 24, 2025
Paradigm Senior Management LLC Organization, Dexter, MO LLC, For-profit, Chain home office Operational/Managerial Control Apr 3, 2023 100%
Adp of the SNF Mar 17, 2025
Individual Adp of the SNF Jun 1, 2023
Dalen Hutchinson Individual Corporate OfficerCfo Nov 1, 2022
Operational/Managerial Control Apr 3, 2023
Adp of the SNF Apr 3, 2023
Forvis Mazars LLP Organization, Springfield, MO LLC, Consulting firm Operational/Managerial Control Jan 1, 2025
Adp of the SNF Mar 17, 2025
Paradigm Rehab Services LLC Organization, Dexter, MO LLC, Management services company, For-profit Operational/Managerial Control Sep 1, 2024
Adp of the SNF Mar 17, 2025

Facilities with the same owner 87

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 87

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681344000000",
    "number": "1366997678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S CATALPA ST",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638412017",
            "telephone_number": "573-624-7491",
            "fax_number": "573-624-2061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S CATALPA ST",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638412017",
            "telephone_number": "573-624-7491",
            "fax_number": "573-624-2061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORY LANE OF DEXTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-17",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A",
        "authorized_official_last_name": "SELLS",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-614-7472"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101456309",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://pointclickcare.com/",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "https://pointclickcare.com/",
            "address_1": "415 S Catalpa St",
            "city": "Dexter",
            "state": "MO",
            "country_code": "US",
            "postal_code": "638412017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Memory Lane of Dexter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dexter, MO

Sources for this page

Verify at the official NPI Registry.