OrganizationActive
Memory Lane Assisted Living
NPI 1114722097 · Assisted Living Facility · Apple Valley, MN
Provider details
- NPI number
- 1114722097
- Entity type
- Organization
- Primary specialty
- Assisted Living FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Abdiasis Hirsi, Director(612) 298-0555
Specialties & taxonomies
Nursing & Custodial Care Facilities
- In Home Supportive Care Agency253Z00000X
Agencies
- Respite Care385H00000X
Respite Care Facility
Profile Score
Established profile(55/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
1 yr in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
15117 Emory Cir
Apple Valley, MN 55124-1808
Phone: (612) 298-0555
Approximate (ZIP-level) locationGet directions
Mailing address
15117 Emory Cir
Apple Valley, MN 55124-1808
Registry dates
- Enumerated
- 2025-02-15
- Last updated
- 2025-02-15
- Certified
- 2025-02-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.