MEMORY LANE COTTAGE, LLC (NPI# 1740664887) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740664887 |
| Entity Type | Organization |
| Organization Name | MEMORY LANE COTTAGE, LLC |
| Other Organization Name | MEMORY LANE COTTAGE |
| Practice Address |
5175 Cypress Preserve Dr Tampa FL 33647-3674 |
| Practice Telephone | 8136321270 |
| Practice Fax Number | 8136321272 |
| Mailing Telephone | 8136321270 |
| Mailing Fax Number | 8136321272 |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2015-07-18 |
| Authorized Official Name | ROBERT MATRAZZO (COO) |
| Authorized Official Telephone | 3054445007 |
| Authorized Official Credential | J.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320700000X | Residential Treatment Facility, Physical Disabilities | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Memory Lane Cottage | Doing Business As Name - Organization |
| Street Address |
5175 CYPRESS PRESERVE DR |
| City | TAMPA |
| State | FL |
| Zip Code | 33647-3674 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558972935 | Innovative Healthcare of Florida, Inc. | Home Health | 8903 Bruce B Downs Blvd, Tampa, FL 33647 | 2020-08-11 |
| 1093331498 | Envision In-home Companion Svcs | Home Health | 8903 Bruce B. Downs Blvd, Suite #140, Tampa, FL 33647 | 2020-06-22 |
| 1538788344 | Deanna Rene Shelpman | Massage Therapist | 15443 Plantation Oaks Dr, Apt 13, Tampa, FL 33647 | 2020-04-11 |
| 1316598998 | Paramount Health Group LLC | In Home Supportive Care | 17425 Bridge Hill Crt. Unit 200b, Tampa, FL 33647 | 2019-09-24 |
| 1174185656 | S&k Management Services | Clinical Nurse Specialist | 19046 Bruce B. Downs Blvd, Ste 177, Tampa, FL 33647 | 2019-07-03 |
| 1760040133 | Calisia Sapp | Clinic/Center | 19046 Bruce B Downs Blvd Ste B6-703, Tampa, FL 33647 | 2019-05-31 |
| 1306400106 | B2b Apps Solutions, LLC | Durable Medical Equipment & Medical Supplies | 17931 Cachet Isle Drive, Tampa, FL 33647 | 2019-04-26 |
| 1376000919 | Florida Homecare Specialists Minority Corp | Home Health | 5331 Primrose Lake Circle Unit 116, Tampa, FL 33647 | 2019-03-01 |
| 1982188157 | Dynamic Support Solutions, LLC | Home Health | 8606 Baneberry Ct, Tampa, FL 33647 | 2018-09-24 |
| 1982197430 | Erika Mendoza-hutto | Nurse Practitioner | 20713 Center Oak Dr, Tampa, FL 33647 | 2018-06-10 |
| Find all providers in zip 33647 | ||||
| Taxonomy Code | 320700000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Physical Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346759115 | Speedway Plus 2 Car Care Center LLCc | Residential Treatment Facility, Physical Disabilities | 8007 Glenoak Rd., Tampa, FL 33610 | 2017-09-25 |
| 1477945277 | Velma Butcher | Residential Treatment Facility, Physical Disabilities | 3703 N 55th St, Tampa, FL 33619-1425 | 2015-03-03 |
| 1881144293 | Asriel Lopez | Residential Treatment Facility, Physical Disabilities | 3211 W Sitka St, Tampa, FL 33614-2701 | 2016-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538782271 | Cordell & Associates LLC | Residential Treatment Facility, Physical Disabilities | 2921 Swoop Cir, Kissimmee, FL 34741-7838 | 2020-05-27 |
| 1427688597 | Lashena Jackson | Residential Treatment Facility, Physical Disabilities | 5677 Chirping Way W, Jacksonville, FL 32222-2310 | 2020-01-17 |
| 1518478353 | Derwin T Callahan | Residential Treatment Facility, Physical Disabilities | 113 Bethune St, Lake Placid, FL 33852-5698 | 2017-10-19 |
| 1700300092 | Martinez Group Home, LLC | Residential Treatment Facility, Physical Disabilities | 14918 Sw 15 Ln, Miami, FL 33194 | 2017-07-28 |
| 1962935452 | Sharyn Trapp | Residential Treatment Facility, Physical Disabilities | 1820 N Westmoreland Dr, Orlando, FL 32804-5738 | 2017-04-11 |
| 1942741921 | Endeavor Swallowing Solutions | Residential Treatment Facility, Physical Disabilities | 8826 Shell Island Dr, Jacksonville, FL 32216-4706 | 2017-03-10 |
| 1366993404 | Steve Ewald | Residential Treatment Facility, Physical Disabilities | 5595 Willoughby Dr, Melbourne, FL 32934-2822 | 2016-10-24 |
| 1518413921 | Las Delicias Alf #2 | Residential Treatment Facility, Physical Disabilities | 3840 Nw 184th St, Miami Gardens, FL 33055-2835 | 2016-08-27 |
| 1780137455 | Axiom | Residential Treatment Facility, Physical Disabilities | 2400 River Tree Cir, Sanford, FL 32771-8332 | 2016-07-29 |
| 1750746616 | Design Woods Peace Trust | Residential Treatment Facility, Physical Disabilities | 209 Runyon Vlg Apt B, Belle Glade, FL 33430-6038 | 2015-12-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.