Memory Lane LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

MEMORY LANE LLC

Practice address

1642 Lisa Ave
Vista, CA 92084-3054

Phone

(760) 445-3639

NPI assigned

Apr 8, 2024

Organization subpart

No

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

Authorized official

Name

Mrs. Amy Michelle Wombolt, CDP

Title

Owner

Phone

(760) 445-3639

Specialties & licenses 1

Addresses

Tax ID family

Memory Lane LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Memory Lane LLC

  • Personal Care Attendant
  • Vista, CA
  • NPI 1194690800
  NPD tax ID

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

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1922851435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1642 LISA AVE",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920843054",
            "telephone_number": "760-445-3639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1642 LISA AVE",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920843054",
            "telephone_number": "760-445-3639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORY LANE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-08",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "WOMBOLT",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-445-3639",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CDP"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Hurd Medical Corporation
• Rebecca Mellman, PT
• Julia Lynn Mellusi, LCSW
• Melrose Square Dental Office
• Memory Lane LLC
• Cynthia Mendez Sanchez
• Christopher Raul Mendez
• Hailey Ashley Mendez
• Leslie Mendez
• Cory Mendoza

• In Home Supportive Care Agency in Vista, CA
• Providers in Vista, CA by specialty
• In Home Supportive Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; 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.