# VINTAGE PARK AT HOLTON, LLC

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

## Provider details

- **NPI number:** 1730337965
- **Authorized official:** MR. MATT MOORE (PRESIDENT)
- **Authorized official phone:** (949) 282-5800

## Contact information

- **Practice address:** 410 JUNIPER DR, HOLTON, KS 66436-1535
- **Practice address phone:** (785) 364-5051
- **Practice address fax:** (785) 364-5010
- **Mailing address:** 410 JUNIPER DR, HOLTON, KS 66436-1535
- **Mailing address phone:** (785) 364-5051
- **Mailing address fax:** (785) 364-5010

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 08/29/2008
- **Last updated:** 08/29/2008

## Other identifiers

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