# VINTAGE PARK AT EUREKA, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Vintage Park at Eureka
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629225107
- **Authorized official:** MR. MATT MOORE (PRESIDENT)
- **Authorized official phone:** (949) 282-5800

## Contact information

- **Practice address:** 1820 E RIVER ST, EUREKA, KS 67045-2156
- **Practice address phone:** (620) 583-7473
- **Practice address fax:** (620) 583-7574
- **Mailing address:** 1820 E RIVER ST, EUREKA, KS 67045-2156
- **Mailing address phone:** (620) 583-7473
- **Mailing address fax:** (620) 583-7574

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | BEING APPLIED FOR | KS | Yes |

## Other

- **Enumeration date:** 08/26/2008
- **Last updated:** 08/26/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | BEING APPLIED FOR | — | KS |