Memory Lane Cottage at Oviedo, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MEMORY LANE COTTAGE AT OVIEDO, LLC

Practice address

450 Oviedo Blvd
Oviedo, FL 32765-3508

Phone

(407) 366-2770

NPI assigned

Aug 8, 2017

Last updated

Nov 18, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kelly Jean Irish, CORE

Title

Executive Director

Phone

(813) 428-3350

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1502150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731888000000",
    "number": "1861917171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 PONCE DE LEON BLVD STE 950",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331343047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 OVIEDO BLVD",
            "city": "OVIEDO",
            "state": "FL",
            "postal_code": "327653508",
            "telephone_number": "407-366-2770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORY LANE COTTAGE AT OVIEDO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-08",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A",
        "authorized_official_last_name": "IRISH",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "813-428-3350",
        "authorized_official_credential": "CORE"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Eugenia Maria Menelas, RPH
• Cherie Menzel, A.P.
• Pamela Lynn Menzel, APRN
• Monique Mercado

• Assisted Living Facility in Oviedo, FL
• Providers in Oviedo, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.