Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Memory Lane Assisted Living

Organization In Home Supportive Care Agency · NPI 1114722097

Memory Lane Assisted Living is an In Home Supportive Care Agency in Apple Valley, Minnesota. Registered with an NPI since 2025.

In the registry since
2025
Specialties on file
3

Practice location Address checks out

15117 Emory Cir
Apple Valley, MN 55124-1808
Phone: (612) 298-0555
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Assisted Living Facility (primary) Taxonomy 310400000X
In Home Supportive Care Agency Taxonomy 253Z00000X
Respite Care Taxonomy 385H00000X

Record details

NPI number1114722097
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Abdiasis Hirsi — Director · (612) 298-0555
NPI enumeratedFebruary 15, 2025
Last updated in NPPESFebruary 15, 2025
Certification dateFebruary 15, 2025
Mailing address15117 Emory Cir, Apple Valley, MN 55124-1808

Other providers in Apple Valley