NPIMap

Organization Active NPI

Memory Lane Cottage at Tampa Palms, LLC

Doing business as Memory Lane Cottage

  • Assisted Living Facility
  • Tampa, FL
National Provider Identifier
1740664887
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
MEMORY LANE COTTAGE AT TAMPA PALMS, LLC
Doing business as
Memory Lane Cottage
Practice address
5175 Cypress Preserve Dr
Tampa, FL 33647-3674
Phone
(813) 632-1270
Fax
(813) 632-1272
NPI assigned
Jul 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Authorized official

Name
Kelly Jean Irish
Title
Administrator
Phone
(813) 632-1270

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

5175 Cypress Preserve Dr
Tampa, FL 33647-3674

Mailing address

5175 Cypress Preserve Dr
Tampa, FL 33647-3674
Phone (813) 632-1270

Other names 1

  • Memory Lane Cottage Doing business as

National Provider Directory

National Provider Directory

Locations

5175 Cypress Preserve Dr
Tampa, FL 33647
Phone (813) 632-1270

NPI Registry JSON

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

{
    "created_epoch": "1437177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694476800000",
    "number": "1740664887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5175 CYPRESS PRESERVE DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336473674",
            "telephone_number": "813-632-1270",
            "fax_number": "813-632-1272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5175 CYPRESS PRESERVE DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336473674",
            "telephone_number": "813-632-1270",
            "fax_number": "813-632-1272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORY LANE COTTAGE AT TAMPA PALMS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-18",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A",
        "authorized_official_last_name": "IRISH",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "813-632-1270"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memory Lane Cottage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.