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VAN BUREN LEGACY LLC
NPI 1407320658
Assisted Living Facility in Van Buren, AR

Active since January 21, 2019CLIA 04D2193755 · Waiver
1012 FAYETTEVILLE RD, VAN BUREN, AR 72956(479) 474-7233(479) 474-3444 Get Directions Write a Review

NPPES record last updated: January 21, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Van Buren Legacy Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VAN BUREN LEGACY LLC (NPI 1407320658) is a healthcare organization registered as an assisted living facility in Van Buren, Arkansas and active in the NPI registry since January 2019. The organization holds a CLIA Waiver certificate valid through September 23, 2026 and lists Tiffany Perryman, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1407320658
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameVAN BUREN LEGACY LLC
Location Address1012 FAYETTEVILLE RDVan Buren, AR 72956-3471
Mailing Address1012 Fayetteville RdVan Buren, AR 72956-3471 · (479) 474-7233 · Fax (479) 474-3444
Phone(479) 474-7233
Fax(479) 474-3444
Organization SubpartNo
Authorized OfficialTiffany PerrymanExecutive Director · (479) 474-7233
Enumeration DateJanuary 21, 2019
✔ NPI 1407320658 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
Also ListedAlzheimer Center (Dementia Center)Taxonomy 311500000X
1012 FAYETTEVILLE RD, Van Buren, AR 72956
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 04D2193755

Van Buren Legacy LLC (memory Lane) · Van Buren, AR
Active · expires Sep 23, 2026
CLIA Number04D2193755
Laboratory TypeAssisted Living Facility
Certificate Effective DateSeptember 24, 2024
Certificate Expiration DateSeptember 23, 2026
Laboratory DirectorLadonna Syrock
Laboratory Phone(479) 474-7233
Laboratory LocationVan Buren Legacy LLC (memory Lane)1012 Fayetteville Road, Van Buren, AR 72956
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MEMORY LANE, INC.
Assisted Living Facility
1012 FAYETTEVILLE RD
VAN BUREN, AR 72956
Crawford County (479) 474-7223

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Van Buren Legacy LLC's NPI number?

The NPI number for Van Buren Legacy LLC is 1407320658. It was assigned to this organization in the NPPES registry on January 21, 2019.

Where is Van Buren Legacy LLC located?

Van Buren Legacy LLC is located at 1012 Fayetteville Rd, Van Buren, AR 72956. The listed phone number is (479) 474-7233.

What is Van Buren Legacy LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Van Buren Legacy LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 04D2193755) is associated with this NPI, valid through September 23, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Van Buren Legacy LLC was last updated on January 21, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.