# VINTAGE PLACE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255643698
- **Authorized official:** MR. BRIAN WARREN (OWNER)
- **Authorized official phone:** (316) 733-1144

## Contact information

- **Practice address:** 1650 E 12TH AVE, EL DORADO, KS 67042-4300
- **Practice address phone:** (316) 321-7777
- **Practice address fax:** (316) 321-6115
- **Mailing address:** 1650 E 12TH AVE, EL DORADO, KS 67042-4300
- **Mailing address phone:** (316) 321-7777
- **Mailing address fax:** (316) 321-6115

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | N008009 | KS | Yes |
| 311500000X | Alzheimer Center (Dementia Center) | N008009 | KS | — |

## Other

- **Enumeration date:** 07/13/2010
- **Last updated:** 07/13/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | N008009 | STATE ASSISTED LIVING PROVIDER LICENSE NUMBER | KS |