# VINTAGE PARK AT OTTAWA LLC

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

## Provider details

- **NPI number:** 1619185188
- **Authorized official:** MR. MATT MOORE (SENIOR VICE PRESIDENT)
- **Authorized official phone:** (913) 239-0660

## Contact information

- **Practice address:** 2250 S ELM ST, OTTAWA, KS 66067
- **Practice address phone:** (785) 242-3715
- **Practice address fax:** (785) 242-0188
- **Mailing address:** 2250 S ELM ST, OTTAWA, KS 66067
- **Mailing address phone:** (785) 242-3715
- **Mailing address fax:** (785) 242-0188

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | N030008 | KS | Yes |

## Other

- **Enumeration date:** 05/18/2007
- **Last updated:** 08/22/2020